CPT 23472 · professional fee

Reconstruct shoulder joint (CPT 23472): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 23472, from their published in-network rate files.

Orthopedic surgerySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$2,318

P10 to P90: $1,489 to $4,096

vs Medicare

178%

non-facility rate $1,300.30

Payer spread

1.35×

UHC $2,567 vs Aetna $1,906

State spread

3.7×

AK $6,424 to TX $1,738

5,036 sampled providers6,081 TINs51 statesSample-based · how this is calculated

What the data shows

Generated from this code's own numbers

UnitedHealthcare has the highest median for CPT 23472 in the files analyzed, at $2,567, 35% above Aetna ($1,906), the lowest of the 4 payers shown.

The state spread is 3.7×: Alaska has the highest median at $6,424 and Texas the lowest at $1,738, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 178% of the Medicare non-facility rate ($1,300.30), which ranks 71st of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $872) and widest within UnitedHealthcare ($1,435).

This is a top-8 code for orthopedic surgery by Medicare allowed dollars, so it carries real revenue weight for that specialty.

Rates by payer

Median of per-provider median rates, with interquartile range

Payer	Median	P25	P75	vs national	Rank	Providers	Position
UnitedHealthcare	$2,567	$1,950	$3,385	+11%	1	4,263	197% of Medicare
Cigna	$2,411	$1,925	$3,125	+4%	2	4,049	185% of Medicare
Blue Cross Blue Shield	$2,346	$1,770	$2,934	+1%	3	3,861	180% of Medicare
Aetna	$1,906	$1,504	$2,377	-18%	4	2,942	147% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($1,300.30)

Rates by state

Median across payers · 51 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$6,424	+177%	Aetna	BCBS	63
2	Wisconsin	$3,528	+52%	BCBS	Aetna	92
3	Wyoming	$3,328	+44%	BCBS	UHC	65
4	South Dakota	$3,298	+42%	UHC	Cigna	97
5	Connecticut	$3,109	+34%	UHC	Aetna	114
6	New Jersey	$3,085	+33%	UHC	Aetna	95
7	Washington	$3,081	+33%	UHC	Aetna	101
8	District of Columbia	$3,074	+33%	Aetna	BCBS	35
9	Iowa	$3,052	+32%	UHC	BCBS	104
10	Mississippi	$2,985	+29%	Aetna	Cigna	112
11	Nebraska	$2,910	+26%	Cigna	BCBS	95
12	North Dakota	$2,870	+24%	BCBS	Aetna	45
13	Oregon	$2,830	+22%	UHC	Aetna	92
14	Massachusetts	$2,737	+18%	UHC	Aetna	111
15	Georgia	$2,652	+14%	UHC	BCBS	124
16	Tennessee	$2,650	+14%	BCBS	Aetna	114
17	North Carolina	$2,618	+13%	Cigna	Aetna	128
18	Rhode Island	$2,567	+11%	UHC	Aetna	98
19	Vermont	$2,496	+8%	UHC	BCBS	35
20	Idaho	$2,446	+6%	Aetna	UHC	120
21	Illinois	$2,377	+3%	UHC	BCBS	103
22	Colorado	$2,346	+1%	UHC	Aetna	106
23	Alabama	$2,320	+0%	BCBS	Cigna	118
24	Montana	$2,284	-1%	UHC	Cigna	79
25	South Carolina	$2,274	-2%	BCBS	Aetna	106
26	Arkansas	$2,261	-2%	Cigna	Aetna	119
27	Maryland	$2,258	-3%	UHC	BCBS	105
28	New Hampshire	$2,257	-3%	Cigna	Aetna	118
29	Kansas	$2,232	-4%	Cigna	Aetna	108
30	New York	$2,226	-4%	Cigna	Aetna	110
31	Virginia	$2,179	-6%	UHC	BCBS	105
32	New Mexico	$2,167	-7%	UHC	BCBS	104
33	Utah	$2,127	-8%	UHC	BCBS	96
34	West Virginia	$2,114	-9%	UHC	Aetna	87
35	Pennsylvania	$2,088	-10%	UHC	Aetna	103
36	Arizona	$2,044	-12%	UHC	Aetna	99
37	Delaware	$2,039	-12%	Cigna	BCBS	59
38	Maine	$2,034	-12%	UHC	Aetna	93
39	Kentucky	$2,033	-12%	UHC	Aetna	124
40	Ohio	$2,022	-13%	UHC	Aetna	110
41	Louisiana	$2,019	-13%	BCBS	Aetna	103
42	Michigan	$2,019	-13%	BCBS	UHC	102
43	Missouri	$2,012	-13%	UHC	Aetna	112
44	Nevada	$1,997	-14%	BCBS	Aetna	108
45	Indiana	$1,862	-20%	UHC	Aetna	115
46	Minnesota	$1,840	-21%	UHC	Aetna	98
47	Florida	$1,836	-21%	BCBS	Aetna	108
48	California	$1,815	-22%	Cigna	Aetna	109
49	Hawaii	$1,796	-23%	BCBS	Cigna	68
50	Oklahoma	$1,742	-25%	UHC	Aetna	100
51	Texas	$1,738	-25%	UHC	Aetna	121

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 23472?

In the files we analyzed, UnitedHealthcare, at a median of $2,567 across 4,263 sampled providers. Aetna is lowest at $1,906, 35% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 178% of the 2026 Medicare non-facility rate of $1,300.30.

Which state has the highest median for CPT 23472?

Alaska has the highest median at $6,424; Texas has the lowest at $1,738.

Is this the surgeon, physician or facility payment?

These are professional (physician) fees only. Facility, device and implant payments are priced separately and are not included.

How current is this data?

It is the August 2026 snapshot of each payer's in-network rate file. Sources and filters are listed in the methodology below.

Methodology

How these numbers are calculated

Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.

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