CPT 43235 · professional fee

Egd diagnostic brush wash (CPT 43235): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 43235, from their published in-network rate files.

GastroenterologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$294

P10 to P90: $153 to $612

vs Medicare

266%

facility rate $110.56

Payer spread

2.27×

UHC $472 vs Aetna $208

State spread

4.2×

OR $772 to MI $183

4,438 sampled providers5,128 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 43235 in the files analyzed, at $472, 127% above Aetna ($208), the lowest of the 4 payers shown.

The state spread is 4.2×: Oregon has the highest median at $772 and Michigan the lowest at $183, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 266% of the Medicare facility rate ($110.56), which ranks 7th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within UnitedHealthcare (interquartile range $242) and widest within Blue Cross Blue Shield ($200).

This is a top-14 code for gastroenterology by Medicare allowed dollars, so it carries real revenue weight for that specialty.

The Medicare comparison uses the facility rate: the non-facility rate ($322.65) is 2.9× higher because it includes device or supply cost that professional-fee contracts do not.

Rates by payer

Median of per-provider median rates, with interquartile range

Payer	Median	P25	P75	vs national	Rank	Providers	Position
UnitedHealthcare	$472	$370	$612	+61%	1	3,743	427% of Medicare
Blue Cross Blue Shield	$289	$197	$397	-2%	2	3,499	262% of Medicare
Cigna	$248	$194	$337	-16%	3	3,569	224% of Medicare
Aetna	$208	$155	$289	-29%	4	3,144	188% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare facility ($110.56)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Oregon	$772	+163%	BCBS	Aetna	104
2	Alaska	$627	+113%	n/a	n/a	16
3	Wisconsin	$514	+75%	BCBS	Cigna	106
4	Nebraska	$479	+63%	UHC	Cigna	46
5	Mississippi	$414	+41%	BCBS	Cigna	92
6	Minnesota	$402	+37%	UHC	Aetna	90
7	Vermont	$400	+36%	BCBS	Cigna	23
8	North Carolina	$397	+35%	UHC	Aetna	124
9	Washington	$394	+34%	UHC	Aetna	97
10	Idaho	$380	+29%	UHC	Cigna	52
11	Hawaii	$378	+28%	UHC	Cigna	45
12	New Hampshire	$375	+28%	UHC	Aetna	74
13	Connecticut	$370	+26%	UHC	Aetna	122
14	Massachusetts	$368	+25%	UHC	Aetna	113
15	Georgia	$327	+11%	UHC	Cigna	127
16	Iowa	$323	+10%	UHC	Aetna	55
17	North Dakota	$317	+8%	UHC	BCBS	20
18	Louisiana	$304	+3%	UHC	Cigna	123
19	New York	$298	+1%	UHC	Aetna	131
20	Virginia	$298	+1%	UHC	BCBS	118
21	Missouri	$297	+1%	UHC	Aetna	135
22	Tennessee	$296	+1%	UHC	Aetna	110
23	District of Columbia	$292	-1%	UHC	BCBS	51
24	South Carolina	$291	-1%	BCBS	Aetna	116
25	Ohio	$291	-1%	UHC	Cigna	123
26	New Jersey	$288	-2%	UHC	Aetna	116
27	Kansas	$287	-2%	UHC	Aetna	62
28	South Dakota	$282	-4%	UHC	BCBS	25
29	Pennsylvania	$279	-5%	UHC	Aetna	114
30	Alabama	$270	-8%	UHC	Cigna	115
31	Kentucky	$261	-11%	UHC	Aetna	124
32	Indiana	$258	-12%	UHC	Aetna	110
33	Rhode Island	$258	-12%	UHC	Aetna	66
34	Maryland	$258	-12%	UHC	BCBS	110
35	California	$255	-13%	UHC	Aetna	107
36	Utah	$255	-13%	UHC	BCBS	86
37	Arizona	$254	-14%	UHC	BCBS	97
38	West Virginia	$251	-15%	UHC	BCBS	49
39	Delaware	$250	-15%	UHC	Cigna	29
40	Florida	$246	-16%	UHC	Cigna	120
41	Illinois	$245	-17%	UHC	BCBS	115
42	Colorado	$237	-19%	UHC	Cigna	125
43	New Mexico	$231	-21%	UHC	Aetna	58
44	Maine	$231	-21%	UHC	Aetna	53
45	Texas	$230	-22%	UHC	Aetna	132
46	Arkansas	$220	-25%	UHC	Aetna	81
47	Nevada	$214	-27%	UHC	Aetna	84
48	Oklahoma	$208	-29%	UHC	Aetna	98
49	Montana	$191	-35%	UHC	Cigna	28
50	Michigan	$183	-38%	UHC	Aetna	113

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 43235?

In the files we analyzed, UnitedHealthcare, at a median of $472 across 3,743 sampled providers. Aetna is lowest at $208, 127% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 266% of the 2026 Medicare facility rate of $110.56.

Which state has the highest median for CPT 43235?

Oregon has the highest median at $772; Michigan has the lowest at $183.

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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