CPT 43249 · professional fee

Esoph egd dilation <30 mm (CPT 43249): negotiated rates by payer and state

Q: Which payer has the highest median rate for CPT 43249?

In the files we analyzed, UnitedHealthcare, at a median of $314 across 3,605 sampled providers. Aetna is lowest at $231, 36% lower than the highest.

Q: How does the commercial rate compare with Medicare?

The national median is 199% of the 2026 Medicare facility rate of $136.28.

Q: Which state has the highest median for CPT 43249?

Alaska has the highest median at $707; Delaware has the lowest at $195.

Q: 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.

Q: 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.

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 43249, from their published in-network rate files.

GastroenterologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$271

P10 to P90: $177 to $516

vs Medicare

199%

facility rate $136.28

Payer spread

1.36×

UHC $314 vs Aetna $231

State spread

3.6×

AK $707 to DE $195

4,363 sampled providers5,083 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 43249 in the files analyzed, at $314, 36% above Aetna ($231), the lowest of the 4 payers shown.

The state spread is 3.6×: Alaska has the highest median at $707 and Delaware the lowest at $195, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 199% of the Medicare facility rate ($136.28), which ranks 37th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Cigna (interquartile range $115) and widest within UnitedHealthcare ($184).

This is a top-16 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 ($1,180.39) is 8.7× 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	$314	$247	$431	+16%	1	3,605	230% of Medicare
Blue Cross Blue Shield	$294	$209	$380	+9%	2	3,395	216% of Medicare
Cigna	$260	$219	$335	-4%	3	3,425	190% of Medicare
Aetna	$231	$184	$295	-15%	4	3,050	169% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare facility ($136.28)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$707	+161%	n/a	n/a	16
2	Wisconsin	$500	+84%	UHC	Aetna	107
3	Minnesota	$380	+40%	UHC	Aetna	90
4	Mississippi	$376	+39%	UHC	Cigna	92
5	New York	$372	+37%	BCBS	Aetna	130
6	New Hampshire	$361	+33%	UHC	Aetna	73
7	Nebraska	$360	+33%	UHC	BCBS	46
8	District of Columbia	$336	+24%	UHC	BCBS	51
9	Washington	$334	+23%	UHC	Aetna	95
10	Georgia	$332	+23%	BCBS	UHC	126
11	Massachusetts	$329	+21%	UHC	Aetna	113
12	Connecticut	$319	+18%	UHC	Aetna	122
13	Alabama	$315	+16%	BCBS	Cigna	115
14	South Dakota	$309	+14%	UHC	BCBS	25
15	Oregon	$308	+14%	UHC	Aetna	68
16	North Dakota	$305	+12%	BCBS	UHC	20
17	Iowa	$301	+11%	UHC	Aetna	56
18	Idaho	$295	+9%	Aetna	Cigna	52
19	North Carolina	$293	+8%	BCBS	Aetna	124
20	Tennessee	$283	+5%	UHC	Aetna	109
21	Arizona	$281	+4%	UHC	BCBS	98
22	New Jersey	$281	+4%	UHC	Aetna	116
23	Missouri	$278	+2%	UHC	Aetna	135
24	South Carolina	$268	-1%	BCBS	Aetna	115
25	Louisiana	$266	-2%	UHC	BCBS	121
26	Pennsylvania	$265	-2%	UHC	Cigna	114
27	New Mexico	$265	-2%	UHC	BCBS	58
28	Ohio	$262	-3%	UHC	BCBS	123
29	Utah	$261	-4%	Aetna	BCBS	79
30	Kentucky	$260	-4%	UHC	Aetna	124
31	Vermont	$259	-4%	n/a	n/a	22
32	Indiana	$259	-4%	BCBS	Aetna	110
33	Maine	$258	-5%	UHC	Aetna	53
34	Arkansas	$258	-5%	UHC	Aetna	81
35	Kansas	$256	-5%	BCBS	Aetna	61
36	Illinois	$255	-6%	UHC	BCBS	115
37	Virginia	$247	-9%	Aetna	BCBS	118
38	Colorado	$246	-9%	UHC	Aetna	126
39	Hawaii	$245	-9%	n/a	n/a	26
40	Florida	$239	-12%	UHC	Aetna	117
41	Montana	$239	-12%	UHC	Cigna	28
42	Rhode Island	$236	-13%	UHC	BCBS	66
43	Oklahoma	$235	-13%	UHC	Aetna	98
44	Maryland	$232	-14%	Aetna	BCBS	110
45	West Virginia	$229	-15%	UHC	BCBS	49
46	California	$226	-17%	UHC	Aetna	104
47	Texas	$225	-17%	UHC	Aetna	132
48	Michigan	$211	-22%	UHC	Aetna	113
49	Nevada	$206	-24%	BCBS	Aetna	84
50	Delaware	$195	-28%	UHC	Aetna	29

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 43249?

In the files we analyzed, UnitedHealthcare, at a median of $314 across 3,605 sampled providers. Aetna is lowest at $231, 36% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 199% of the 2026 Medicare facility rate of $136.28.

Which state has the highest median for CPT 43249?

Alaska has the highest median at $707; Delaware has the lowest at $195.

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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