CPT 99203 · professional fee

Office o/p new low 30 min (CPT 99203): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 99203, from their published in-network rate files.

Orthopedic surgery UrologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$118

P10 to P90: $78 to $218

vs Medicare

100%

non-facility rate $117.57

Payer spread

1.59×

UHC $149 vs Aetna $94

State spread

2.6×

AK $205 to AL $78

39,082 sampled providers36,217 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 99203 in the files analyzed, at $149, 59% above Aetna ($94), the lowest of the 4 payers shown.

The state spread is 2.6×: Alaska has the highest median at $205 and Alabama the lowest at $78, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 100% of the Medicare non-facility rate ($117.57), which ranks 196th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $35) and widest within UnitedHealthcare ($94).

This is a top-7 code for orthopedic surgery 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	$149	$113	$206	+27%	1	31,635	127% of Medicare
Cigna	$120	$91	$154	+2%	2	31,292	102% of Medicare
Blue Cross Blue Shield	$118	$98	$149	+0%	3	30,442	100% of Medicare
Aetna	$94	$79	$115	-20%	4	26,560	80% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($117.57)

Rates by state

Median across payers · 51 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$205	+74%	UHC	Cigna	328
2	Oregon	$188	+59%	UHC	Aetna	808
3	Wisconsin	$184	+56%	UHC	Aetna	867
4	Washington	$175	+49%	UHC	Aetna	868
5	Massachusetts	$160	+36%	UHC	Aetna	920
6	Nebraska	$160	+35%	UHC	Aetna	601
7	North Dakota	$147	+25%	UHC	Aetna	343
8	Wyoming	$146	+24%	UHC	Aetna	270
9	New Hampshire	$145	+23%	UHC	Aetna	732
10	South Dakota	$144	+22%	UHC	Aetna	473
11	Hawaii	$143	+21%	UHC	Aetna	502
12	Minnesota	$142	+21%	UHC	Aetna	851
13	District of Columbia	$140	+19%	UHC	Aetna	520
14	Georgia	$138	+17%	UHC	Aetna	978
15	Vermont	$135	+14%	UHC	Aetna	340
16	North Carolina	$134	+14%	UHC	Aetna	1,009
17	Idaho	$133	+13%	UHC	BCBS	616
18	Montana	$128	+9%	UHC	Aetna	447
19	Maine	$127	+8%	UHC	Aetna	647
20	Colorado	$127	+8%	UHC	Aetna	944
21	Connecticut	$126	+7%	UHC	Aetna	933
22	New Jersey	$123	+4%	UHC	Aetna	885
23	Pennsylvania	$121	+3%	UHC	Aetna	887
24	Ohio	$119	+1%	UHC	Aetna	934
25	Iowa	$119	+1%	UHC	Aetna	712
26	New Mexico	$116	-1%	UHC	BCBS	621
27	Utah	$116	-2%	UHC	Aetna	816
28	California	$115	-3%	UHC	Aetna	844
29	Illinois	$115	-3%	UHC	BCBS	883
30	Tennessee	$113	-4%	UHC	Aetna	942
31	Delaware	$111	-6%	UHC	Aetna	459
32	New York	$111	-6%	UHC	Aetna	942
33	Indiana	$110	-6%	UHC	Aetna	961
34	Virginia	$110	-6%	UHC	Aetna	901
35	Michigan	$110	-7%	Cigna	Aetna	868
36	Kansas	$109	-7%	Cigna	Aetna	790
37	Missouri	$109	-7%	UHC	Aetna	952
38	Oklahoma	$108	-8%	UHC	Aetna	836
39	West Virginia	$108	-8%	UHC	BCBS	607
40	Rhode Island	$108	-9%	UHC	BCBS	632
41	Kentucky	$105	-11%	UHC	Aetna	976
42	South Carolina	$104	-12%	UHC	Aetna	865
43	Nevada	$104	-12%	UHC	Aetna	776
44	Louisiana	$103	-13%	UHC	Cigna	914
45	Mississippi	$103	-13%	BCBS	Aetna	777
46	Arkansas	$102	-13%	UHC	Aetna	786
47	Florida	$102	-14%	UHC	Aetna	887
48	Texas	$101	-14%	UHC	BCBS	1,020
49	Maryland	$101	-15%	UHC	BCBS	848
50	Arizona	$93	-21%	UHC	BCBS	814
51	Alabama	$78	-34%	UHC	Aetna	950

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 99203?

In the files we analyzed, UnitedHealthcare, at a median of $149 across 31,635 sampled providers. Aetna is lowest at $94, 59% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 100% of the 2026 Medicare non-facility rate of $117.57.

Which state has the highest median for CPT 99203?

Alaska has the highest median at $205; Alabama has the lowest at $78.

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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