CPT 43238 · professional fee

Egd us fine needle bx/aspir (CPT 43238): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 43238, from their published in-network rate files.

GastroenterologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$383

P10 to P90: $241 to $710

vs Medicare

188%

non-facility rate $204.41

Payer spread

1.40×

UHC $436 vs Aetna $311

State spread

3.3×

AK $923 to HI $283

4,419 sampled providers5,125 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 43238 in the files analyzed, at $436, 40% above Aetna ($311), the lowest of the 4 payers shown.

The state spread is 3.3×: Alaska has the highest median at $923 and Hawaii the lowest at $283, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 188% of the Medicare non-facility rate ($204.41), which ranks 54th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Cigna (interquartile range $193) and widest within Blue Cross Blue Shield ($231).

This is a top-36 code for gastroenterology 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	$436	$338	$572	+14%	1	3,759	213% of Medicare
Cigna	$393	$320	$513	+3%	2	3,593	192% of Medicare
Blue Cross Blue Shield	$370	$289	$520	-3%	3	3,550	181% of Medicare
Aetna	$311	$246	$427	-19%	4	2,433	152% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($204.41)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$923	+141%	n/a	n/a	16
2	Wisconsin	$831	+117%	UHC	Aetna	106
3	Oregon	$710	+85%	UHC	Aetna	104
4	New Hampshire	$523	+37%	UHC	Aetna	74
5	Connecticut	$523	+36%	UHC	Aetna	122
6	Nebraska	$516	+35%	UHC	BCBS	46
7	Minnesota	$510	+33%	UHC	Aetna	91
8	Washington	$504	+31%	UHC	Aetna	95
9	Georgia	$503	+31%	BCBS	UHC	125
10	Iowa	$501	+31%	Cigna	BCBS	55
11	North Carolina	$473	+24%	BCBS	Aetna	124
12	Mississippi	$470	+23%	BCBS	Cigna	91
13	South Dakota	$468	+22%	BCBS	UHC	25
14	North Dakota	$461	+20%	BCBS	UHC	20
15	Idaho	$456	+19%	Aetna	Cigna	52
16	Massachusetts	$452	+18%	UHC	Aetna	113
17	Tennessee	$418	+9%	UHC	Aetna	109
18	Vermont	$403	+5%	UHC	BCBS	23
19	New Mexico	$398	+4%	UHC	BCBS	58
20	New Jersey	$397	+4%	Cigna	Aetna	116
21	Missouri	$396	+3%	UHC	Aetna	135
22	Utah	$395	+3%	Aetna	BCBS	88
23	Ohio	$390	+2%	UHC	BCBS	123
24	Kentucky	$389	+1%	UHC	BCBS	124
25	Kansas	$383	+0%	Cigna	Aetna	62
26	Colorado	$378	-1%	UHC	BCBS	122
27	Arizona	$378	-1%	UHC	BCBS	98
28	Rhode Island	$372	-3%	Aetna	BCBS	66
29	Louisiana	$372	-3%	UHC	BCBS	120
30	Maine	$367	-4%	UHC	Aetna	53
31	Illinois	$365	-5%	UHC	BCBS	115
32	Montana	$360	-6%	UHC	BCBS	28
33	Arkansas	$360	-6%	UHC	Aetna	81
34	District of Columbia	$355	-7%	Cigna	BCBS	51
35	South Carolina	$355	-7%	BCBS	Aetna	112
36	Alabama	$352	-8%	Aetna	Cigna	114
37	West Virginia	$346	-10%	UHC	Aetna	49
38	Pennsylvania	$343	-10%	UHC	Aetna	114
39	Indiana	$340	-11%	UHC	Aetna	110
40	California	$339	-11%	Cigna	Aetna	108
41	Virginia	$339	-12%	UHC	BCBS	116
42	Florida	$339	-12%	UHC	Aetna	117
43	New York	$318	-17%	UHC	BCBS	131
44	Michigan	$316	-18%	UHC	Aetna	111
45	Oklahoma	$308	-20%	UHC	Aetna	98
46	Maryland	$305	-20%	UHC	BCBS	110
46	Delaware	$305	-20%	UHC	Cigna	29
48	Texas	$289	-25%	Cigna	BCBS	132
49	Nevada	$288	-25%	BCBS	Aetna	84
50	Hawaii	$283	-26%	Cigna	UHC	45

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 43238?

In the files we analyzed, UnitedHealthcare, at a median of $436 across 3,759 sampled providers. Aetna is lowest at $311, 40% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 188% of the 2026 Medicare non-facility rate of $204.41.

Which state has the highest median for CPT 43238?

Alaska has the highest median at $923; Hawaii has the lowest at $283.

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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