CPT 76856 · professional fee

Us exam pelvic complete (CPT 76856): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 76856, from their published in-network rate files.

UrologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$148

P10 to P90: $94 to $294

vs Medicare

141%

non-facility rate $105.21

Payer spread

1.32×

Cigna $165 vs Aetna $125

State spread

3.9×

AK $383 to FL $98

4,191 sampled providers4,594 TINs51 statesSample-based · how this is calculated

What the data shows

Generated from this code's own numbers

Cigna has the highest median for CPT 76856 in the files analyzed, at $165, 32% above Aetna ($125), the lowest of the 4 payers shown.

The state spread is 3.9×: Alaska has the highest median at $383 and Florida the lowest at $98, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 141% of the Medicare non-facility rate ($105.21), which ranks 141st of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $55) and widest within UnitedHealthcare ($94).

This is a top-27 code for urology 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
Cigna	$165	$120	$223	+11%	1	3,384	157% of Medicare
Blue Cross Blue Shield	$154	$112	$194	+4%	2	3,161	146% of Medicare
UnitedHealthcare	$149	$119	$214	+1%	3	3,583	142% of Medicare
Aetna	$125	$104	$159	-16%	4	2,462	118% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($105.21)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$383	+159%	n/a	n/a	22
2	Wisconsin	$272	+84%	BCBS	Aetna	113
3	Oregon	$268	+81%	Cigna	Aetna	102
4	Washington	$214	+45%	Cigna	UHC	111
5	South Dakota	$212	+43%	Cigna	UHC	33
6	Nebraska	$200	+35%	Cigna	BCBS	50
7	Iowa	$193	+31%	Cigna	Aetna	82
8	District of Columbia	$192	+30%	Cigna	BCBS	45
9	North Dakota	$188	+27%	n/a	n/a	21
10	North Carolina	$184	+24%	UHC	Aetna	108
11	Idaho	$184	+24%	BCBS	UHC	46
12	Utah	$178	+20%	Aetna	Cigna	76
13	Georgia	$177	+20%	Cigna	BCBS	118
14	New Jersey	$176	+19%	UHC	Aetna	104
15	Minnesota	$175	+18%	BCBS	Aetna	111
16	Colorado	$171	+15%	UHC	Cigna	115
17	California	$167	+13%	UHC	Aetna	95
18	Connecticut	$162	+9%	Cigna	Aetna	114
19	Massachusetts	$154	+4%	Cigna	Aetna	103
20	New Hampshire	$153	+4%	UHC	Aetna	51
21	Hawaii	$152	+3%	BCBS	UHC	28
22	Nevada	$151	+2%	Cigna	UHC	54
23	New York	$151	+2%	Cigna	Aetna	115
24	Mississippi	$151	+2%	BCBS	UHC	67
25	Ohio	$150	+1%	Cigna	UHC	110
26	Pennsylvania	$149	+1%	BCBS	Aetna	108
27	Vermont	$149	+1%	Cigna	BCBS	30
28	Illinois	$146	-2%	UHC	BCBS	107
29	Maryland	$142	-4%	UHC	BCBS	102
30	Maine	$140	-5%	UHC	Aetna	48
31	Rhode Island	$140	-6%	UHC	Aetna	40
32	Virginia	$139	-6%	UHC	Aetna	104
33	Michigan	$136	-8%	BCBS	UHC	112
34	South Carolina	$134	-10%	Cigna	Aetna	97
34	Arkansas	$134	-10%	UHC	Aetna	66
36	West Virginia	$133	-10%	UHC	Aetna	49
37	Alabama	$133	-10%	BCBS	Cigna	116
38	Kentucky	$132	-11%	Cigna	Aetna	115
39	Kansas	$130	-12%	BCBS	Aetna	93
40	Missouri	$130	-12%	Cigna	Aetna	118
41	Delaware	$130	-12%	UHC	Aetna	28
42	New Mexico	$128	-13%	UHC	BCBS	34
43	Tennessee	$127	-14%	BCBS	Aetna	109
44	Montana	$126	-15%	Cigna	BCBS	39
45	Indiana	$124	-16%	Cigna	Aetna	124
46	Louisiana	$122	-18%	Aetna	Cigna	104
47	Arizona	$121	-19%	Cigna	BCBS	99
48	Texas	$113	-24%	UHC	BCBS	124
49	Oklahoma	$98	-34%	UHC	BCBS	108
50	Florida	$98	-34%	BCBS	Aetna	111

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 76856?

In the files we analyzed, Cigna, at a median of $165 across 3,384 sampled providers. Aetna is lowest at $125, 32% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 141% of the 2026 Medicare non-facility rate of $105.21.

Which state has the highest median for CPT 76856?

Alaska has the highest median at $383; Florida has the lowest at $98.

Is this a professional fee?

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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