CPT 43274 · professional fee

Ercp duct stent placement (CPT 43274): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 43274, from their published in-network rate files.

GastroenterologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$739

P10 to P90: $468 to $1,385

vs Medicare

184%

non-facility rate $402.15

Payer spread

1.43×

UHC $852 vs Aetna $595

State spread

4.1×

AK $2,295 to HI $558

4,433 sampled providers5,147 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 43274 in the files analyzed, at $852, 43% above Aetna ($595), the lowest of the 4 payers shown.

The state spread is 4.1×: Alaska has the highest median at $2,295 and Hawaii the lowest at $558, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 184% of the Medicare non-facility rate ($402.15), which ranks 60th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Cigna (interquartile range $390) and widest within Blue Cross Blue Shield ($446).

This is a top-17 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	$852	$658	$1,121	+15%	1	3,764	212% of Medicare
Cigna	$757	$612	$1,002	+2%	2	3,579	188% of Medicare
Blue Cross Blue Shield	$716	$551	$997	-3%	3	3,556	178% of Medicare
Aetna	$595	$481	$789	-19%	4	2,781	148% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($402.15)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$2,295	+211%	n/a	n/a	16
2	Wisconsin	$1,511	+104%	BCBS	Aetna	107
3	Oregon	$1,332	+80%	UHC	Aetna	104
4	Connecticut	$1,126	+52%	UHC	Aetna	122
5	New Hampshire	$1,056	+43%	UHC	Aetna	74
6	Nebraska	$1,024	+39%	Cigna	BCBS	46
7	Minnesota	$1,011	+37%	UHC	Aetna	91
8	Washington	$1,002	+36%	UHC	Aetna	97
9	Georgia	$963	+30%	BCBS	UHC	126
10	Iowa	$944	+28%	UHC	Aetna	55
11	Mississippi	$939	+27%	BCBS	Cigna	92
12	South Dakota	$931	+26%	BCBS	UHC	25
13	Massachusetts	$892	+21%	UHC	Aetna	113
14	North Dakota	$877	+19%	BCBS	UHC	20
15	North Carolina	$869	+18%	BCBS	Aetna	124
16	Idaho	$836	+13%	Aetna	Cigna	52
17	Tennessee	$790	+7%	UHC	Aetna	109
18	New Jersey	$784	+6%	Cigna	Aetna	116
19	Alabama	$782	+6%	Aetna	Cigna	115
20	Vermont	$758	+3%	UHC	BCBS	23
21	Utah	$757	+2%	Aetna	BCBS	88
22	New Mexico	$735	-1%	UHC	BCBS	58
23	Maine	$733	-1%	UHC	Aetna	53
24	Arizona	$731	-1%	UHC	Aetna	98
25	Arkansas	$730	-1%	UHC	Aetna	81
26	Louisiana	$720	-2%	UHC	Aetna	122
27	Colorado	$720	-3%	UHC	Aetna	124
28	Montana	$716	-3%	UHC	Cigna	28
29	District of Columbia	$709	-4%	UHC	BCBS	51
30	West Virginia	$690	-7%	UHC	BCBS	49
31	Missouri	$690	-7%	UHC	Aetna	135
32	Kentucky	$689	-7%	UHC	BCBS	124
33	Illinois	$689	-7%	UHC	Aetna	115
34	Kansas	$684	-7%	UHC	BCBS	62
35	Ohio	$684	-7%	UHC	Aetna	123
36	Pennsylvania	$683	-8%	UHC	BCBS	114
37	Rhode Island	$662	-10%	Cigna	BCBS	66
38	Virginia	$657	-11%	UHC	BCBS	117
39	South Carolina	$651	-12%	BCBS	Aetna	115
40	Florida	$626	-15%	UHC	Aetna	117
41	Maryland	$623	-16%	UHC	BCBS	110
42	Michigan	$621	-16%	UHC	Aetna	112
43	California	$616	-17%	Cigna	Aetna	108
44	Oklahoma	$615	-17%	UHC	Aetna	98
45	Delaware	$611	-17%	UHC	Aetna	29
46	New York	$608	-18%	Cigna	BCBS	131
47	Indiana	$578	-22%	UHC	BCBS	109
48	Nevada	$574	-22%	UHC	Aetna	84
49	Texas	$570	-23%	Cigna	Aetna	132
50	Hawaii	$558	-24%	UHC	Cigna	45

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 43274?

In the files we analyzed, UnitedHealthcare, at a median of $852 across 3,764 sampled providers. Aetna is lowest at $595, 43% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 184% of the 2026 Medicare non-facility rate of $402.15.

Which state has the highest median for CPT 43274?

Alaska has the highest median at $2,295; Hawaii has the lowest at $558.

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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