CPT 43276 · professional fee

Ercp stent exchange w/dilate (CPT 43276): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 43276, from their published in-network rate files.

GastroenterologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$771

P10 to P90: $488 to $1,445

vs Medicare

184%

non-facility rate $419.18

Payer spread

1.40×

UHC $883 vs Aetna $631

State spread

3.3×

AK $1,913 to HI $581

4,417 sampled providers5,126 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 43276 in the files analyzed, at $883, 40% above Aetna ($631), the lowest of the 4 payers shown.

The state spread is 3.3×: Alaska has the highest median at $1,913 and Hawaii the lowest at $581, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 184% of the Medicare non-facility rate ($419.18), which ranks 58th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Cigna (interquartile range $406) and widest within Aetna ($386).

This is a top-31 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	$883	$685	$1,166	+14%	1	3,758	211% of Medicare
Cigna	$787	$637	$1,043	+2%	2	3,579	188% of Medicare
Blue Cross Blue Shield	$734	$564	$999	-5%	3	3,552	175% of Medicare
Aetna	$631	$501	$886	-18%	4	2,428	150% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($419.18)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$1,913	+148%	n/a	n/a	16
2	Wisconsin	$1,574	+104%	BCBS	Aetna	106
3	Oregon	$1,471	+91%	UHC	Cigna	104
4	Connecticut	$1,172	+52%	UHC	Aetna	121
5	New Hampshire	$1,147	+49%	UHC	Aetna	73
6	Nebraska	$1,067	+38%	Cigna	BCBS	46
7	Minnesota	$1,051	+36%	UHC	Aetna	91
8	Washington	$1,043	+35%	UHC	Aetna	95
9	Georgia	$999	+30%	BCBS	UHC	126
10	Iowa	$983	+27%	UHC	BCBS	55
11	South Dakota	$970	+26%	BCBS	UHC	25
12	Massachusetts	$928	+20%	UHC	Aetna	113
13	Idaho	$926	+20%	Aetna	Cigna	52
14	North Dakota	$912	+18%	BCBS	UHC	20
15	North Carolina	$909	+18%	BCBS	Aetna	124
16	Mississippi	$859	+11%	Aetna	Cigna	92
17	Tennessee	$845	+9%	UHC	Aetna	108
18	New Jersey	$823	+7%	Cigna	Aetna	116
19	Alabama	$816	+6%	Aetna	Cigna	115
20	Utah	$806	+4%	Aetna	BCBS	88
21	Vermont	$789	+2%	UHC	BCBS	23
22	New Mexico	$788	+2%	UHC	BCBS	58
23	Louisiana	$769	-0%	UHC	Aetna	120
24	Maine	$763	-1%	UHC	Aetna	53
25	Arkansas	$760	-2%	UHC	Aetna	81
26	Colorado	$750	-3%	UHC	Aetna	123
27	District of Columbia	$748	-3%	UHC	BCBS	51
28	Montana	$745	-3%	UHC	BCBS	28
29	Arizona	$736	-5%	UHC	BCBS	98
30	Ohio	$736	-5%	UHC	BCBS	123
31	South Carolina	$734	-5%	BCBS	Aetna	112
32	Illinois	$723	-6%	UHC	Aetna	115
33	Missouri	$719	-7%	UHC	Aetna	135
33	West Virginia	$719	-7%	UHC	BCBS	49
35	Kentucky	$717	-7%	UHC	BCBS	124
36	Pennsylvania	$712	-8%	UHC	BCBS	114
37	Kansas	$712	-8%	UHC	BCBS	62
38	Rhode Island	$689	-11%	Cigna	BCBS	66
39	Virginia	$683	-11%	UHC	BCBS	115
40	New York	$659	-15%	Cigna	BCBS	131
41	Florida	$656	-15%	UHC	Aetna	117
42	Michigan	$648	-16%	UHC	Aetna	111
43	Oklahoma	$644	-17%	UHC	BCBS	98
44	California	$635	-18%	Cigna	Aetna	108
45	Maryland	$604	-22%	UHC	BCBS	109
46	Indiana	$601	-22%	UHC	BCBS	109
47	Nevada	$598	-23%	UHC	Aetna	84
48	Texas	$596	-23%	Cigna	BCBS	132
49	Delaware	$592	-23%	UHC	Aetna	29
50	Hawaii	$581	-25%	Cigna	UHC	45

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 43276?

In the files we analyzed, UnitedHealthcare, at a median of $883 across 3,758 sampled providers. Aetna is lowest at $631, 40% 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 $419.18.

Which state has the highest median for CPT 43276?

Alaska has the highest median at $1,913; Hawaii has the lowest at $581.

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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