CPT 55874 · professional fee

Tprnl plmt biodegrdabl matrl (CPT 55874): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 55874, from their published in-network rate files.

UrologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$257

P10 to P90: $165 to $457

vs Medicare

180%

facility rate $142.62

Payer spread

1.38×

UHC $292 vs Aetna $211

State spread

3.7×

AK $657 to AL $180

4,154 sampled providers4,640 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 55874 in the files analyzed, at $292, 38% above Aetna ($211), the lowest of the 4 payers shown.

The state spread is 3.7×: Alaska has the highest median at $657 and Alabama the lowest at $180, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 180% of the Medicare facility rate ($142.62), which ranks 65th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Cigna (interquartile range $130) and widest within Blue Cross Blue Shield ($136).

This is a top-21 code for urology by Medicare allowed dollars, so it carries real revenue weight for that specialty.

The Medicare comparison uses the facility rate: the non-facility rate ($3,704.49) is 26.0× 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	$292	$230	$380	+13%	1	3,404	204% of Medicare
Cigna	$262	$220	$350	+2%	2	3,114	184% of Medicare
Blue Cross Blue Shield	$249	$189	$324	-3%	3	3,024	175% of Medicare
Aetna	$211	$172	$282	-18%	4	2,196	148% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare facility ($142.62)

Rates by state

Median across payers · 49 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$657	+156%	n/a	n/a	22
2	Wisconsin	$505	+96%	BCBS	Aetna	113
3	Oregon	$431	+68%	Cigna	Aetna	98
4	District of Columbia	$365	+42%	Cigna	BCBS	46
5	Washington	$342	+33%	UHC	BCBS	110
6	Connecticut	$340	+32%	Cigna	Aetna	116
7	New Hampshire	$337	+31%	UHC	Aetna	50
8	Nebraska	$330	+28%	Cigna	BCBS	50
9	South Dakota	$328	+28%	Cigna	BCBS	33
10	North Dakota	$312	+21%	n/a	n/a	21
11	Minnesota	$303	+18%	UHC	Aetna	111
12	Massachusetts	$301	+17%	UHC	Aetna	112
13	New Jersey	$296	+15%	Cigna	Aetna	105
14	North Carolina	$295	+15%	UHC	Aetna	123
15	Georgia	$287	+12%	UHC	Aetna	118
16	Iowa	$285	+11%	Cigna	BCBS	82
17	Illinois	$276	+8%	UHC	Cigna	106
18	Nevada	$275	+7%	Aetna	BCBS	57
19	Vermont	$270	+5%	n/a	n/a	23
20	Ohio	$269	+5%	UHC	BCBS	109
21	New York	$266	+3%	Cigna	Aetna	111
22	Maine	$263	+2%	UHC	BCBS	48
23	Colorado	$262	+2%	UHC	Aetna	113
24	Idaho	$261	+1%	Aetna	BCBS	45
25	Utah	$256	-0%	UHC	Cigna	68
25	Montana	$256	-0%	UHC	BCBS	39
27	New Mexico	$256	-1%	UHC	BCBS	32
28	Mississippi	$253	-1%	Aetna	UHC	65
29	South Carolina	$253	-2%	BCBS	Aetna	100
30	Maryland	$252	-2%	UHC	BCBS	102
31	Arkansas	$251	-2%	UHC	Aetna	66
32	Kansas	$250	-3%	Aetna	Cigna	93
33	Pennsylvania	$245	-5%	UHC	Aetna	107
34	Tennessee	$243	-6%	Cigna	Aetna	106
35	Missouri	$240	-7%	UHC	Aetna	119
36	Virginia	$239	-7%	UHC	BCBS	103
37	Rhode Island	$236	-8%	UHC	BCBS	40
38	Louisiana	$233	-9%	UHC	BCBS	101
39	West Virginia	$229	-11%	UHC	BCBS	49
40	Texas	$225	-13%	UHC	BCBS	124
41	Florida	$223	-13%	UHC	Aetna	112
42	Indiana	$221	-14%	UHC	Aetna	116
43	Michigan	$220	-14%	UHC	Aetna	110
44	Oklahoma	$218	-15%	UHC	Aetna	108
45	Kentucky	$216	-16%	UHC	BCBS	114
46	California	$210	-18%	UHC	Aetna	92
47	Arizona	$209	-19%	UHC	BCBS	99
48	Delaware	$187	-27%	UHC	Aetna	29
49	Alabama	$180	-30%	Aetna	BCBS	117

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 55874?

In the files we analyzed, UnitedHealthcare, at a median of $292 across 3,404 sampled providers. Aetna is lowest at $211, 38% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 180% of the 2026 Medicare facility rate of $142.62.

Which state has the highest median for CPT 55874?

Alaska has the highest median at $657; Alabama has the lowest at $180.

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.

See how your contracts compare for CPT 55874

Benchmark your negotiated rates for 55874 and the rest of your book against these payer and state medians.

Request a rate benchmark