CPT 43248 · professional fee

Egd guide wire insertion (CPT 43248): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 43248, from their published in-network rate files.

GastroenterologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$364

P10 to P90: $198 to $800

vs Medicare

246%

facility rate $147.97

Payer spread

2.36×

UHC $625 vs Aetna $264

State spread

2.9×

WI $672 to NV $236

4,430 sampled providers5,098 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 43248 in the files analyzed, at $625, 136% above Aetna ($264), the lowest of the 4 payers shown.

The state spread is 2.9×: Wisconsin has the highest median at $672 and Nevada the lowest at $236, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 246% of the Medicare facility rate ($147.97), which ranks 16th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Cigna (interquartile range $166) and widest within Blue Cross Blue Shield ($239).

This is a top-18 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 ($457.93) is 3.1× 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	$625	$439	$831	+72%	1	3,742	422% of Medicare
Blue Cross Blue Shield	$365	$250	$489	+0%	2	3,512	246% of Medicare
Cigna	$311	$251	$417	-15%	3	3,526	210% of Medicare
Aetna	$264	$200	$343	-27%	4	2,864	179% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare facility ($147.97)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Wisconsin	$672	+85%	BCBS	Aetna	106
2	Alaska	$663	+82%	n/a	n/a	16
3	Oregon	$653	+79%	BCBS	Aetna	102
4	Minnesota	$545	+50%	UHC	Aetna	90
5	Hawaii	$538	+48%	UHC	Cigna	45
6	Washington	$519	+43%	UHC	Aetna	96
7	Nebraska	$515	+41%	UHC	BCBS	46
8	New Hampshire	$507	+39%	UHC	Aetna	74
9	Connecticut	$475	+31%	UHC	Aetna	122
10	Idaho	$467	+28%	Aetna	Cigna	52
11	Mississippi	$455	+25%	UHC	Cigna	92
12	Georgia	$442	+22%	UHC	Cigna	126
13	District of Columbia	$438	+20%	UHC	BCBS	51
14	North Carolina	$436	+20%	UHC	Aetna	124
15	Massachusetts	$431	+19%	UHC	BCBS	113
16	North Dakota	$428	+18%	UHC	BCBS	20
17	New York	$404	+11%	UHC	Aetna	131
18	New Jersey	$389	+7%	UHC	Aetna	116
19	Missouri	$383	+5%	UHC	Aetna	135
20	Tennessee	$382	+5%	UHC	Aetna	108
21	South Dakota	$378	+4%	UHC	BCBS	25
22	Pennsylvania	$372	+2%	UHC	Aetna	113
23	Iowa	$372	+2%	UHC	Aetna	55
24	Vermont	$371	+2%	UHC	BCBS	23
25	South Carolina	$369	+1%	UHC	Aetna	115
26	Alabama	$365	+0%	UHC	Cigna	115
27	Utah	$345	-5%	UHC	Cigna	88
28	Louisiana	$337	-7%	UHC	BCBS	121
29	Ohio	$331	-9%	UHC	BCBS	123
30	Indiana	$325	-11%	UHC	Aetna	110
31	Illinois	$324	-11%	UHC	Aetna	115
32	Kansas	$323	-11%	UHC	Aetna	62
33	Virginia	$321	-12%	UHC	BCBS	118
34	Maryland	$319	-12%	UHC	BCBS	110
35	Arizona	$317	-13%	UHC	BCBS	98
36	Florida	$312	-14%	UHC	Aetna	120
37	California	$310	-15%	UHC	Aetna	107
38	Arkansas	$300	-18%	UHC	Aetna	81
39	Colorado	$299	-18%	UHC	Aetna	125
40	New Mexico	$297	-18%	UHC	BCBS	58
41	Maine	$294	-19%	UHC	Aetna	53
42	West Virginia	$293	-20%	UHC	BCBS	49
43	Kentucky	$289	-21%	UHC	BCBS	124
44	Oklahoma	$267	-27%	UHC	Aetna	98
45	Rhode Island	$266	-27%	UHC	BCBS	66
46	Delaware	$260	-29%	UHC	Cigna	29
47	Montana	$258	-29%	UHC	BCBS	28
48	Texas	$257	-29%	UHC	Aetna	132
49	Michigan	$245	-33%	UHC	Aetna	112
50	Nevada	$236	-35%	UHC	Aetna	84

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 43248?

In the files we analyzed, UnitedHealthcare, at a median of $625 across 3,742 sampled providers. Aetna is lowest at $264, 136% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 246% of the 2026 Medicare facility rate of $147.97.

Which state has the highest median for CPT 43248?

Wisconsin has the highest median at $672; Nevada has the lowest at $236.

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.

See how your contracts compare for CPT 43248

Benchmark your negotiated rates for 43248 and the rest of your book against these payer and state medians.

Request a rate benchmark