CPT 43242 · professional fee

Egd us fine needle bx/aspir (CPT 43242): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 43242, from their published in-network rate files.

GastroenterologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$454

P10 to P90: $275 to $852

vs Medicare

198%

non-facility rate $229.80

Payer spread

1.37×

UHC $511 vs Aetna $374

State spread

3.8×

AK $1,213 to HI $318

4,426 sampled providers5,077 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 43242 in the files analyzed, at $511, 37% above Aetna ($374), the lowest of the 4 payers shown.

The state spread is 3.8×: Alaska has the highest median at $1,213 and Hawaii the lowest at $318, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 198% of the Medicare non-facility rate ($229.80), which ranks 38th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within UnitedHealthcare (interquartile range $260) and widest within Blue Cross Blue Shield ($354).

This is a top-25 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	$511	$402	$662	+13%	1	3,759	222% of Medicare
Cigna	$471	$373	$617	+4%	2	3,590	205% of Medicare
Blue Cross Blue Shield	$441	$324	$678	-3%	3	3,512	192% of Medicare
Aetna	$374	$282	$509	-18%	4	2,504	163% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($229.80)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$1,213	+167%	n/a	n/a	16
2	Wisconsin	$858	+89%	BCBS	Aetna	107
3	Oregon	$805	+77%	UHC	Aetna	104
4	Connecticut	$662	+46%	UHC	Aetna	122
5	New Hampshire	$652	+44%	UHC	Aetna	74
6	Minnesota	$634	+40%	UHC	Aetna	91
7	North Carolina	$585	+29%	BCBS	Aetna	124
8	Nebraska	$583	+29%	UHC	BCBS	46
9	Washington	$570	+26%	UHC	BCBS	95
10	Georgia	$568	+25%	BCBS	UHC	125
11	Iowa	$564	+24%	Cigna	BCBS	55
12	Massachusetts	$560	+23%	UHC	Aetna	113
13	Vermont	$543	+20%	UHC	BCBS	23
14	North Dakota	$536	+18%	UHC	BCBS	20
15	South Dakota	$529	+17%	BCBS	UHC	25
16	Alabama	$526	+16%	BCBS	Cigna	115
17	Idaho	$516	+14%	Aetna	Cigna	52
18	Tennessee	$494	+9%	UHC	Aetna	108
19	Indiana	$479	+6%	BCBS	Aetna	110
20	Ohio	$472	+4%	UHC	Cigna	123
21	New Mexico	$469	+3%	UHC	BCBS	58
22	New Jersey	$455	+0%	Cigna	Aetna	116
23	South Carolina	$450	-1%	BCBS	Aetna	115
24	Kansas	$448	-1%	UHC	Aetna	62
25	Arizona	$447	-1%	UHC	BCBS	98
26	Utah	$447	-1%	UHC	BCBS	88
27	Colorado	$446	-2%	UHC	Cigna	124
28	District of Columbia	$444	-2%	Cigna	BCBS	51
29	Kentucky	$440	-3%	UHC	Aetna	124
30	Louisiana	$440	-3%	UHC	Aetna	120
31	Missouri	$438	-3%	UHC	Cigna	135
32	Illinois	$430	-5%	UHC	BCBS	115
33	Mississippi	$430	-5%	Aetna	BCBS	92
34	California	$429	-5%	Cigna	BCBS	108
35	Pennsylvania	$424	-7%	UHC	Aetna	113
36	Rhode Island	$422	-7%	Aetna	BCBS	66
37	Maine	$416	-8%	UHC	Aetna	53
38	Arkansas	$413	-9%	UHC	Aetna	81
39	Virginia	$410	-10%	Cigna	BCBS	116
40	Montana	$407	-10%	UHC	Cigna	28
41	West Virginia	$400	-12%	UHC	Aetna	49
42	Florida	$398	-12%	UHC	Cigna	117
43	Delaware	$396	-13%	UHC	Cigna	29
44	New York	$361	-21%	Cigna	BCBS	131
45	Oklahoma	$359	-21%	UHC	Aetna	98
46	Michigan	$355	-22%	UHC	Aetna	112
47	Maryland	$355	-22%	UHC	BCBS	110
48	Nevada	$343	-24%	BCBS	Aetna	84
49	Texas	$326	-28%	Cigna	BCBS	132
50	Hawaii	$318	-30%	UHC	Cigna	45

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 43242?

In the files we analyzed, UnitedHealthcare, at a median of $511 across 3,759 sampled providers. Aetna is lowest at $374, 37% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 198% of the 2026 Medicare non-facility rate of $229.80.

Which state has the highest median for CPT 43242?

Alaska has the highest median at $1,213; Hawaii has the lowest at $318.

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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