CPT 43239 · professional fee

Egd biopsy single/multiple (CPT 43239): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 43239, from their published in-network rate files.

GastroenterologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$349

P10 to P90: $174 to $724

vs Medicare

283%

facility rate $123.58

Payer spread

2.39×

UHC $567 vs Aetna $237

State spread

3.4×

AK $701 to MI $204

4,401 sampled providers5,156 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 43239 in the files analyzed, at $567, 139% above Aetna ($237), the lowest of the 4 payers shown.

The state spread is 3.4×: Alaska has the highest median at $701 and Michigan the lowest at $204, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 283% of the Medicare facility rate ($123.58), which ranks 5th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within UnitedHealthcare (interquartile range $311) and widest within Aetna ($156).

This is a top-3 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 ($418.85) is 3.4× 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	$567	$451	$761	+62%	1	3,680	459% of Medicare
Blue Cross Blue Shield	$345	$228	$451	-1%	2	3,477	279% of Medicare
Cigna	$277	$221	$377	-21%	3	3,515	224% of Medicare
Aetna	$237	$177	$333	-32%	4	3,187	192% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare facility ($123.58)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$701	+101%	n/a	n/a	16
2	Nebraska	$626	+79%	UHC	Cigna	46
3	Wisconsin	$559	+60%	BCBS	Cigna	106
4	Hawaii	$492	+41%	UHC	Cigna	45
5	North Carolina	$476	+36%	UHC	Aetna	124
6	Washington	$465	+33%	UHC	Aetna	97
7	Minnesota	$458	+31%	UHC	Aetna	90
8	Connecticut	$451	+29%	UHC	Aetna	122
9	Mississippi	$450	+29%	UHC	Cigna	92
10	Massachusetts	$441	+26%	UHC	Aetna	113
11	Idaho	$410	+17%	UHC	Cigna	52
12	Vermont	$400	+14%	UHC	BCBS	23
13	New Hampshire	$398	+14%	UHC	Aetna	74
14	New York	$381	+9%	UHC	Aetna	131
14	North Dakota	$381	+9%	UHC	BCBS	20
16	District of Columbia	$381	+9%	UHC	BCBS	51
17	Louisiana	$380	+9%	UHC	Cigna	123
18	Georgia	$378	+8%	UHC	Cigna	127
19	Oregon	$370	+6%	UHC	Aetna	68
20	Pennsylvania	$365	+5%	UHC	Aetna	114
21	Iowa	$365	+5%	UHC	Aetna	56
22	South Carolina	$363	+4%	BCBS	Aetna	116
23	Indiana	$356	+2%	UHC	Aetna	110
24	Ohio	$346	-1%	UHC	Cigna	123
25	Missouri	$342	-2%	UHC	Aetna	135
26	Tennessee	$339	-3%	UHC	Aetna	110
27	Virginia	$336	-4%	UHC	BCBS	118
28	Alabama	$334	-4%	UHC	Cigna	115
29	New Jersey	$333	-5%	UHC	Aetna	116
30	Kentucky	$326	-7%	UHC	Aetna	124
31	Kansas	$323	-7%	UHC	Aetna	62
32	South Dakota	$316	-10%	UHC	BCBS	25
33	Maryland	$311	-11%	UHC	BCBS	110
34	West Virginia	$303	-13%	UHC	BCBS	49
35	California	$297	-15%	UHC	Aetna	104
36	Florida	$293	-16%	UHC	Cigna	120
37	Utah	$287	-18%	UHC	BCBS	86
38	Arizona	$286	-18%	UHC	BCBS	97
39	Delaware	$284	-19%	UHC	Cigna	29
40	Illinois	$276	-21%	UHC	BCBS	115
41	Rhode Island	$276	-21%	UHC	Aetna	66
42	New Mexico	$271	-22%	UHC	Aetna	58
43	Colorado	$267	-24%	UHC	Aetna	126
44	Texas	$266	-24%	UHC	Aetna	132
45	Maine	$260	-26%	UHC	Aetna	53
46	Arkansas	$250	-29%	UHC	Aetna	81
47	Oklahoma	$235	-33%	UHC	Aetna	98
48	Nevada	$230	-34%	UHC	Aetna	84
49	Montana	$216	-38%	UHC	Cigna	28
50	Michigan	$204	-42%	UHC	Aetna	113

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 43239?

In the files we analyzed, UnitedHealthcare, at a median of $567 across 3,680 sampled providers. Aetna is lowest at $237, 139% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 283% of the 2026 Medicare facility rate of $123.58.

Which state has the highest median for CPT 43239?

Alaska has the highest median at $701; Michigan has the lowest at $204.

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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