CPT 43246 · professional fee

Egd place gastrostomy tube (CPT 43246): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 43246, from their published in-network rate files.

GastroenterologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$338

P10 to P90: $211 to $617

vs Medicare

189%

non-facility rate $178.36

Payer spread

1.37×

UHC $377 vs Aetna $274

State spread

3.3×

AK $799 to HI $241

4,434 sampled providers5,141 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 43246 in the files analyzed, at $377, 37% above Aetna ($274), the lowest of the 4 payers shown.

The state spread is 3.3×: Alaska has the highest median at $799 and Hawaii the lowest at $241, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 189% of the Medicare non-facility rate ($178.36), which ranks 48th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Cigna (interquartile range $170) and widest within Blue Cross Blue Shield ($230).

This is a top-38 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	$377	$290	$495	+12%	1	3,759	211% of Medicare
Cigna	$340	$279	$449	+1%	2	3,598	191% of Medicare
Blue Cross Blue Shield	$339	$259	$490	+0%	3	3,547	190% of Medicare
Aetna	$274	$225	$388	-19%	4	2,663	154% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($178.36)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$799	+137%	n/a	n/a	16
2	Wisconsin	$714	+111%	UHC	Cigna	106
3	Oregon	$615	+82%	UHC	Aetna	104
4	Minnesota	$476	+41%	UHC	Aetna	91
5	New Hampshire	$451	+33%	UHC	Aetna	74
6	Connecticut	$450	+33%	UHC	Aetna	121
7	Nebraska	$439	+30%	UHC	BCBS	46
8	Georgia	$433	+28%	BCBS	UHC	127
9	Iowa	$432	+28%	Cigna	BCBS	55
10	Washington	$432	+28%	UHC	BCBS	95
11	Mississippi	$419	+24%	BCBS	Cigna	92
12	Alabama	$400	+18%	BCBS	Cigna	115
13	South Dakota	$398	+18%	BCBS	UHC	25
14	North Dakota	$398	+18%	BCBS	UHC	20
15	Idaho	$392	+16%	Aetna	Cigna	52
16	Massachusetts	$391	+16%	UHC	Aetna	113
17	North Carolina	$380	+12%	BCBS	Aetna	124
18	Tennessee	$363	+8%	UHC	Aetna	109
19	Indiana	$352	+4%	BCBS	Aetna	110
20	New Mexico	$348	+3%	UHC	BCBS	58
21	New Jersey	$343	+1%	Cigna	Aetna	116
22	Missouri	$342	+1%	UHC	Aetna	135
23	Arizona	$341	+1%	UHC	BCBS	98
24	Utah	$341	+1%	UHC	BCBS	88
25	District of Columbia	$338	+0%	Aetna	BCBS	51
26	Vermont	$336	-1%	UHC	BCBS	23
27	Ohio	$336	-1%	UHC	Cigna	123
28	Kentucky	$336	-1%	UHC	BCBS	124
29	Kansas	$333	-2%	BCBS	Aetna	62
30	Colorado	$332	-2%	UHC	BCBS	123
31	Illinois	$326	-4%	UHC	BCBS	115
32	Louisiana	$324	-4%	UHC	Aetna	123
33	Rhode Island	$322	-5%	Aetna	BCBS	66
34	Arkansas	$321	-5%	UHC	Aetna	81
35	Montana	$311	-8%	UHC	Cigna	28
36	Virginia	$311	-8%	UHC	BCBS	118
37	Maine	$307	-9%	UHC	Aetna	53
38	South Carolina	$305	-10%	BCBS	Aetna	114
39	Maryland	$305	-10%	Aetna	BCBS	110
40	California	$303	-10%	UHC	Aetna	108
41	Pennsylvania	$303	-10%	UHC	BCBS	115
42	West Virginia	$302	-11%	UHC	Aetna	49
43	Michigan	$295	-13%	UHC	Aetna	111
44	Florida	$294	-13%	BCBS	Cigna	120
45	Delaware	$290	-14%	Aetna	Cigna	29
46	New York	$278	-18%	UHC	Aetna	131
47	Oklahoma	$265	-22%	UHC	Aetna	98
48	Texas	$250	-26%	Cigna	BCBS	132
49	Nevada	$249	-26%	BCBS	Aetna	84
50	Hawaii	$241	-29%	Cigna	UHC	45

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 43246?

In the files we analyzed, UnitedHealthcare, at a median of $377 across 3,759 sampled providers. Aetna is lowest at $274, 37% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 189% of the 2026 Medicare non-facility rate of $178.36.

Which state has the highest median for CPT 43246?

Alaska has the highest median at $799; Hawaii has the lowest at $241.

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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