CPT 99205 · professional fee

Office o/p new hi 60 min (CPT 99205): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 99205, from their published in-network rate files.

Cardiology GastroenterologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$239

P10 to P90: $159 to $443

vs Medicare

101%

non-facility rate $236.81

Payer spread

1.56×

UHC $291 vs Aetna $187

State spread

2.9×

AK $443 to AL $155

39,062 sampled providers36,078 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 99205 in the files analyzed, at $291, 56% above Aetna ($187), the lowest of the 4 payers shown.

The state spread is 2.9×: Alaska has the highest median at $443 and Alabama the lowest at $155, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 101% of the Medicare non-facility rate ($236.81), which ranks 195th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $68) and widest within UnitedHealthcare ($180).

This is a top-19 code for cardiology 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	$291	$219	$399	+22%	1	31,635	123% of Medicare
Cigna	$254	$191	$323	+6%	2	31,292	107% of Medicare
Blue Cross Blue Shield	$238	$200	$313	-0%	3	30,458	100% of Medicare
Aetna	$187	$161	$229	-22%	4	25,468	79% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($236.81)

Rates by state

Median across payers · 51 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$443	+85%	UHC	Cigna	322
2	Wisconsin	$399	+67%	UHC	Aetna	867
3	Oregon	$386	+62%	UHC	Aetna	807
4	Washington	$358	+50%	UHC	Aetna	872
5	Massachusetts	$340	+42%	UHC	Aetna	920
6	Nebraska	$339	+42%	UHC	Aetna	601
7	Wyoming	$322	+35%	UHC	Aetna	270
8	South Dakota	$319	+34%	UHC	Aetna	473
9	North Dakota	$306	+28%	BCBS	Aetna	343
10	New Hampshire	$305	+28%	UHC	Aetna	733
11	District of Columbia	$297	+24%	UHC	Aetna	519
12	Minnesota	$287	+20%	UHC	Aetna	851
13	Georgia	$285	+19%	UHC	Aetna	978
14	Idaho	$284	+19%	Cigna	Aetna	616
14	Montana	$284	+19%	UHC	Aetna	447
16	Hawaii	$281	+18%	UHC	Aetna	505
17	Maine	$274	+15%	UHC	Aetna	646
18	North Carolina	$274	+15%	UHC	Aetna	1,007
19	Colorado	$271	+14%	UHC	Aetna	945
20	Connecticut	$267	+12%	UHC	Aetna	932
21	Iowa	$263	+10%	UHC	Aetna	712
22	Vermont	$248	+4%	UHC	Aetna	340
23	Utah	$240	+0%	UHC	Aetna	817
24	New Jersey	$238	-0%	UHC	Aetna	886
25	Illinois	$238	-0%	UHC	Aetna	882
26	Ohio	$236	-1%	UHC	Aetna	934
27	New Mexico	$234	-2%	UHC	BCBS	620
28	Pennsylvania	$233	-2%	UHC	Aetna	885
29	Tennessee	$230	-4%	UHC	Aetna	941
30	Kansas	$228	-5%	Cigna	Aetna	787
31	Virginia	$227	-5%	UHC	Aetna	898
32	Delaware	$222	-7%	UHC	Aetna	458
33	Missouri	$220	-8%	UHC	Aetna	952
34	Oklahoma	$219	-8%	UHC	Aetna	836
35	California	$219	-8%	UHC	Aetna	843
36	West Virginia	$218	-9%	UHC	BCBS	606
37	New York	$215	-10%	UHC	Aetna	939
38	Maryland	$212	-11%	UHC	BCBS	848
39	Michigan	$212	-11%	Cigna	Aetna	869
40	Kentucky	$211	-12%	Cigna	Aetna	976
41	Rhode Island	$211	-12%	UHC	Aetna	632
42	Arkansas	$210	-12%	UHC	Aetna	786
43	South Carolina	$209	-12%	BCBS	Aetna	862
43	Indiana	$209	-12%	UHC	Aetna	961
45	Texas	$206	-14%	UHC	BCBS	1,021
46	Florida	$205	-14%	UHC	Aetna	889
47	Nevada	$205	-14%	UHC	Aetna	778
48	Louisiana	$204	-14%	UHC	Cigna	914
49	Mississippi	$196	-18%	BCBS	Aetna	777
50	Arizona	$187	-22%	UHC	Aetna	809
51	Alabama	$155	-35%	UHC	Aetna	950

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 99205?

In the files we analyzed, UnitedHealthcare, at a median of $291 across 31,635 sampled providers. Aetna is lowest at $187, 56% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 101% of the 2026 Medicare non-facility rate of $236.81.

Which state has the highest median for CPT 99205?

Alaska has the highest median at $443; Alabama has the lowest at $155.

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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