CPT 43255 · professional fee

Egd control bleeding any (CPT 43255): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 43255, from their published in-network rate files.

GastroenterologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$459

P10 to P90: $243 to $1,092

vs Medicare

259%

facility rate $177.02

Payer spread

2.53×

UHC $822 vs Aetna $326

State spread

2.9×

AK $854 to MI $293

4,389 sampled providers5,105 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 43255 in the files analyzed, at $822, 153% above Aetna ($326), the lowest of the 4 payers shown.

The state spread is 2.9×: Alaska has the highest median at $854 and Michigan the lowest at $293, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 259% of the Medicare facility rate ($177.02), which ranks 11th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Cigna (interquartile range $191) and widest within UnitedHealthcare ($587).

This is a top-33 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 ($689.06) is 3.9× 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	$822	$600	$1,186	+79%	1	3,678	464% of Medicare
Blue Cross Blue Shield	$461	$304	$602	+1%	2	3,444	261% of Medicare
Cigna	$385	$316	$507	-16%	3	3,517	218% of Medicare
Aetna	$326	$249	$431	-29%	4	2,924	184% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare facility ($177.02)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$854	+86%	n/a	n/a	16
2	Hawaii	$812	+77%	Cigna	UHC	45
3	Wisconsin	$757	+65%	BCBS	Cigna	107
4	Nebraska	$623	+36%	UHC	BCBS	46
5	Minnesota	$605	+32%	UHC	Aetna	90
6	Mississippi	$595	+30%	UHC	Cigna	92
7	New York	$594	+30%	UHC	Aetna	130
8	Idaho	$589	+28%	BCBS	Cigna	52
9	Connecticut	$580	+26%	UHC	Aetna	122
10	North Carolina	$578	+26%	UHC	Aetna	124
11	Washington	$565	+23%	UHC	Aetna	96
12	Georgia	$559	+22%	UHC	Cigna	126
13	New Hampshire	$553	+21%	UHC	Aetna	74
14	District of Columbia	$550	+20%	UHC	BCBS	51
15	Vermont	$538	+17%	UHC	BCBS	23
16	Missouri	$529	+15%	UHC	Aetna	135
17	New Jersey	$517	+13%	UHC	Aetna	116
18	North Dakota	$516	+12%	BCBS	UHC	20
19	South Carolina	$497	+8%	UHC	Aetna	115
20	Massachusetts	$492	+7%	UHC	BCBS	113
21	Oregon	$490	+7%	UHC	Aetna	68
22	Tennessee	$468	+2%	UHC	Aetna	108
23	Indiana	$463	+1%	UHC	Aetna	110
23	Alabama	$463	+1%	UHC	Cigna	115
25	Pennsylvania	$456	-1%	UHC	Cigna	113
26	Iowa	$452	-1%	UHC	Aetna	55
26	South Dakota	$452	-1%	UHC	BCBS	25
28	Kansas	$442	-4%	UHC	Aetna	62
29	Ohio	$435	-5%	UHC	BCBS	123
30	Arizona	$428	-7%	UHC	BCBS	98
31	Virginia	$423	-8%	UHC	BCBS	117
32	Utah	$418	-9%	UHC	BCBS	87
33	Louisiana	$412	-10%	UHC	Aetna	121
34	Maryland	$409	-11%	UHC	BCBS	110
35	Illinois	$390	-15%	UHC	Aetna	115
36	California	$387	-16%	UHC	Aetna	104
37	Florida	$383	-16%	UHC	Aetna	117
38	Colorado	$382	-17%	UHC	Aetna	125
39	Rhode Island	$381	-17%	UHC	BCBS	66
40	New Mexico	$377	-18%	UHC	BCBS	58
41	Kentucky	$374	-19%	UHC	BCBS	124
42	West Virginia	$372	-19%	UHC	Aetna	49
43	Maine	$365	-20%	UHC	Aetna	53
44	Arkansas	$363	-21%	UHC	Aetna	81
45	Oklahoma	$337	-27%	UHC	Aetna	98
46	Delaware	$313	-32%	UHC	Cigna	29
47	Texas	$312	-32%	UHC	Aetna	132
48	Montana	$310	-32%	UHC	Cigna	28
49	Nevada	$310	-32%	UHC	Aetna	84
50	Michigan	$293	-36%	UHC	Aetna	113

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 43255?

In the files we analyzed, UnitedHealthcare, at a median of $822 across 3,678 sampled providers. Aetna is lowest at $326, 153% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 259% of the 2026 Medicare facility rate of $177.02.

Which state has the highest median for CPT 43255?

Alaska has the highest median at $854; Michigan has the lowest at $293.

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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