CPT 43264 · professional fee

Ercp remove duct calculi (CPT 43264): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 43264, from their published in-network rate files.

GastroenterologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$622

P10 to P90: $380 to $1,131

vs Medicare

196%

non-facility rate $317.31

Payer spread

1.38×

UHC $695 vs Aetna $505

State spread

3.3×

AK $1,446 to HI $440

4,432 sampled providers5,111 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 43264 in the files analyzed, at $695, 38% above Aetna ($505), the lowest of the 4 payers shown.

The state spread is 3.3×: Alaska has the highest median at $1,446 and Hawaii the lowest at $440, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 196% of the Medicare non-facility rate ($317.31), which ranks 39th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Cigna (interquartile range $320) and widest within Blue Cross Blue Shield ($413).

This is a top-22 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	$695	$537	$907	+12%	1	3,759	219% of Medicare
Blue Cross Blue Shield	$656	$473	$886	+5%	2	3,515	207% of Medicare
Cigna	$645	$519	$839	+4%	3	3,603	203% of Medicare
Aetna	$505	$411	$683	-19%	4	2,883	159% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($317.31)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$1,446	+132%	n/a	n/a	16
2	Wisconsin	$1,295	+108%	UHC	Aetna	107
3	Oregon	$1,053	+69%	UHC	Aetna	104
4	Minnesota	$877	+41%	UHC	Aetna	91
5	Connecticut	$874	+40%	UHC	Aetna	122
6	New Hampshire	$867	+39%	UHC	Aetna	74
7	Nebraska	$807	+30%	Cigna	BCBS	46
8	Mississippi	$799	+28%	BCBS	Cigna	92
9	Washington	$789	+27%	UHC	BCBS	96
10	Georgia	$787	+27%	BCBS	UHC	127
11	Iowa	$782	+26%	Cigna	Aetna	55
12	North Carolina	$743	+19%	BCBS	Aetna	124
13	South Dakota	$733	+18%	BCBS	UHC	25
14	Alabama	$729	+17%	BCBS	Cigna	115
15	Idaho	$711	+14%	Aetna	Cigna	52
16	Massachusetts	$704	+13%	UHC	Aetna	113
17	North Dakota	$691	+11%	UHC	BCBS	20
18	Tennessee	$678	+9%	UHC	Aetna	108
19	Utah	$670	+8%	Aetna	BCBS	87
20	Indiana	$651	+5%	BCBS	Aetna	110
21	New Mexico	$640	+3%	UHC	BCBS	58
22	Vermont	$635	+2%	UHC	BCBS	23
23	Colorado	$629	+1%	UHC	BCBS	124
24	Kentucky	$622	+0%	UHC	BCBS	124
25	New Jersey	$621	-0%	Cigna	Aetna	116
26	Arizona	$621	-0%	UHC	BCBS	98
27	Missouri	$616	-1%	UHC	Aetna	135
28	Ohio	$610	-2%	UHC	Aetna	123
29	Kansas	$606	-3%	BCBS	Aetna	62
30	Pennsylvania	$602	-3%	UHC	BCBS	114
31	District of Columbia	$600	-4%	Cigna	BCBS	51
32	Illinois	$590	-5%	UHC	BCBS	115
33	Louisiana	$584	-6%	UHC	Aetna	123
34	Rhode Island	$584	-6%	Aetna	BCBS	66
35	Arkansas	$582	-6%	UHC	Aetna	81
36	Maine	$576	-7%	BCBS	Aetna	53
37	Montana	$563	-10%	UHC	BCBS	28
38	California	$552	-11%	UHC	Aetna	108
39	South Carolina	$547	-12%	BCBS	Aetna	115
40	Maryland	$545	-12%	UHC	BCBS	109
41	West Virginia	$542	-13%	UHC	Aetna	49
42	Virginia	$539	-13%	Cigna	BCBS	117
43	Florida	$532	-14%	UHC	Cigna	117
44	Delaware	$529	-15%	UHC	Aetna	29
45	New York	$498	-20%	Cigna	BCBS	131
46	Michigan	$490	-21%	UHC	Aetna	112
47	Oklahoma	$489	-21%	UHC	Aetna	98
48	Texas	$451	-27%	Cigna	BCBS	132
49	Nevada	$451	-28%	BCBS	Aetna	84
50	Hawaii	$440	-29%	Cigna	UHC	45

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 43264?

In the files we analyzed, UnitedHealthcare, at a median of $695 across 3,759 sampled providers. Aetna is lowest at $505, 38% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 196% of the 2026 Medicare non-facility rate of $317.31.

Which state has the highest median for CPT 43264?

Alaska has the highest median at $1,446; Hawaii has the lowest at $440.

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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