CPT 99204 · professional fee

Office o/p new mod 45 min (CPT 99204): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 99204, from their published in-network rate files.

Urology GastroenterologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$183

P10 to P90: $121 to $337

vs Medicare

103%

non-facility rate $177.36

Payer spread

1.57×

UHC $229 vs Aetna $145

State spread

2.8×

AK $326 to AL $115

39,095 sampled providers36,015 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 99204 in the files analyzed, at $229, 57% above Aetna ($145), the lowest of the 4 payers shown.

The state spread is 2.8×: Alaska has the highest median at $326 and Alabama the lowest at $115, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 103% of the Medicare non-facility rate ($177.36), which ranks 190th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $57) and widest within UnitedHealthcare ($143).

This is a top-4 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
UnitedHealthcare	$229	$172	$315	+25%	1	31,635	129% of Medicare
Cigna	$193	$147	$245	+5%	2	31,292	109% of Medicare
Blue Cross Blue Shield	$180	$152	$238	-2%	3	30,401	102% of Medicare
Aetna	$145	$124	$181	-21%	4	26,616	82% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($177.36)

Rates by state

Median across payers · 51 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$326	+78%	UHC	Cigna	328
2	Wisconsin	$296	+61%	UHC	Aetna	867
3	Oregon	$292	+59%	UHC	Aetna	808
4	Washington	$278	+52%	UHC	Aetna	868
5	Massachusetts	$256	+40%	UHC	Aetna	920
6	Nebraska	$255	+39%	UHC	Aetna	601
7	South Dakota	$244	+33%	UHC	Aetna	473
8	Wyoming	$238	+30%	UHC	Aetna	270
9	North Dakota	$233	+27%	BCBS	Aetna	343
10	New Hampshire	$231	+26%	UHC	Aetna	733
11	Minnesota	$227	+24%	UHC	Aetna	851
12	District of Columbia	$219	+20%	UHC	Aetna	521
13	Georgia	$217	+18%	UHC	Aetna	978
14	Idaho	$216	+18%	UHC	Aetna	617
15	Hawaii	$213	+16%	Cigna	Aetna	504
16	North Carolina	$213	+16%	UHC	Aetna	1,009
17	Montana	$209	+14%	UHC	Aetna	447
18	Maine	$207	+13%	UHC	Aetna	647
19	Connecticut	$206	+12%	UHC	Aetna	933
20	Colorado	$203	+11%	UHC	Aetna	946
21	Vermont	$198	+8%	UHC	Aetna	340
22	Iowa	$194	+6%	UHC	Aetna	712
23	New Jersey	$188	+3%	UHC	Aetna	886
24	New Mexico	$185	+1%	UHC	BCBS	621
25	Pennsylvania	$184	+0%	UHC	Aetna	884
26	Utah	$181	-1%	UHC	Aetna	817
27	Ohio	$179	-2%	UHC	Aetna	935
28	Illinois	$179	-2%	UHC	Aetna	883
29	Tennessee	$178	-3%	UHC	Aetna	942
30	California	$176	-4%	UHC	Aetna	843
31	Virginia	$172	-6%	UHC	Aetna	901
32	Kansas	$171	-7%	Cigna	Aetna	790
33	Missouri	$170	-7%	UHC	Aetna	952
34	New York	$170	-7%	UHC	Aetna	941
35	Indiana	$169	-8%	UHC	Aetna	962
36	Delaware	$168	-8%	UHC	Aetna	458
37	Michigan	$168	-9%	Cigna	Aetna	868
38	Oklahoma	$167	-9%	UHC	Aetna	836
39	Kentucky	$166	-9%	UHC	Aetna	976
40	Rhode Island	$165	-10%	UHC	Cigna	632
41	West Virginia	$164	-10%	UHC	BCBS	607
42	South Carolina	$162	-12%	UHC	Aetna	866
43	Arkansas	$161	-12%	UHC	Aetna	786
44	Louisiana	$161	-12%	UHC	Cigna	915
45	Nevada	$160	-12%	UHC	Aetna	779
46	Maryland	$160	-13%	UHC	BCBS	848
47	Florida	$160	-13%	UHC	Aetna	889
48	Texas	$157	-14%	UHC	BCBS	1,021
49	Mississippi	$156	-15%	BCBS	Aetna	777
50	Arizona	$144	-21%	UHC	Aetna	814
51	Alabama	$115	-37%	UHC	Aetna	950

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 99204?

In the files we analyzed, UnitedHealthcare, at a median of $229 across 31,635 sampled providers. Aetna is lowest at $145, 57% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 103% of the 2026 Medicare non-facility rate of $177.36.

Which state has the highest median for CPT 99204?

Alaska has the highest median at $326; Alabama has the lowest at $115.

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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