CPT 99213 · professional fee

Office o/p est low 20 min (CPT 99213): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 99213, from their published in-network rate files.

Dermatology UrologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$86

P10 to P90: $56 to $159

vs Medicare

90%

non-facility rate $95.19

Payer spread

1.55×

UHC $106 vs Aetna $68

State spread

2.6×

AK $161 to AL $63

39,087 sampled providers36,155 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 99213 in the files analyzed, at $106, 55% above Aetna ($68), the lowest of the 4 payers shown.

The state spread is 2.6×: Alaska has the highest median at $161 and Alabama the lowest at $63, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 90% of the Medicare non-facility rate ($95.19), which ranks 218th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $23) and widest within UnitedHealthcare ($67).

This is the #1 code for dermatology 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	$106	$77	$143	+23%	1	31,635	111% of Medicare
Cigna	$89	$66	$114	+4%	2	31,293	94% of Medicare
Blue Cross Blue Shield	$89	$73	$115	+3%	3	30,395	93% of Medicare
Aetna	$68	$60	$83	-21%	4	26,628	72% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($95.19)

Rates by state

Median across payers · 51 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$161	+87%	UHC	Cigna	328
2	Wisconsin	$143	+66%	UHC	Aetna	867
3	Oregon	$142	+65%	UHC	Aetna	808
4	Washington	$130	+51%	UHC	Aetna	868
5	Nebraska	$126	+47%	UHC	Aetna	601
6	Massachusetts	$122	+41%	UHC	Aetna	920
7	Hawaii	$118	+37%	UHC	Aetna	502
8	Wyoming	$117	+36%	UHC	Aetna	270
9	New Hampshire	$110	+28%	UHC	Aetna	732
10	North Dakota	$107	+24%	BCBS	Aetna	343
11	District of Columbia	$107	+24%	UHC	BCBS	520
12	Minnesota	$105	+22%	BCBS	Aetna	851
13	Montana	$103	+20%	UHC	Aetna	447
14	Idaho	$99	+15%	Cigna	Aetna	616
15	Colorado	$98	+14%	UHC	Aetna	944
16	Georgia	$98	+14%	UHC	Aetna	977
17	South Dakota	$97	+13%	UHC	Aetna	473
18	Iowa	$96	+11%	UHC	Aetna	712
19	Vermont	$96	+11%	UHC	Aetna	340
20	Maine	$95	+10%	UHC	Aetna	647
21	North Carolina	$94	+9%	UHC	Aetna	1,009
22	Connecticut	$91	+6%	UHC	Aetna	933
23	Ohio	$87	+1%	UHC	Aetna	934
24	Illinois	$85	-1%	UHC	Aetna	883
25	Pennsylvania	$85	-1%	UHC	Aetna	885
26	Oklahoma	$83	-3%	BCBS	Aetna	836
27	New Mexico	$83	-3%	UHC	Aetna	621
28	California	$83	-4%	UHC	Aetna	844
29	New Jersey	$82	-4%	UHC	Aetna	886
30	Tennessee	$81	-5%	UHC	Aetna	941
31	Michigan	$80	-7%	Cigna	Aetna	871
32	New York	$80	-7%	UHC	Aetna	941
33	Delaware	$79	-8%	Cigna	Aetna	459
34	Virginia	$79	-8%	UHC	Aetna	900
35	Indiana	$79	-9%	BCBS	Aetna	962
36	Rhode Island	$79	-9%	UHC	Aetna	632
37	Missouri	$78	-9%	UHC	Aetna	952
38	Utah	$77	-11%	UHC	Aetna	817
39	Kansas	$77	-11%	Cigna	Aetna	790
40	Maryland	$75	-12%	UHC	BCBS	848
41	Kentucky	$75	-13%	UHC	Aetna	976
42	South Carolina	$74	-13%	UHC	Aetna	865
43	Texas	$73	-15%	UHC	BCBS	1,020
44	Nevada	$73	-15%	UHC	Aetna	776
45	West Virginia	$73	-15%	UHC	BCBS	607
46	Louisiana	$72	-16%	UHC	Aetna	915
47	Florida	$70	-18%	UHC	Aetna	889
48	Mississippi	$70	-19%	BCBS	Aetna	778
49	Arkansas	$70	-19%	UHC	Aetna	786
50	Arizona	$67	-22%	UHC	BCBS	815
51	Alabama	$63	-27%	UHC	Aetna	950

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 99213?

In the files we analyzed, UnitedHealthcare, at a median of $106 across 31,635 sampled providers. Aetna is lowest at $68, 55% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 90% of the 2026 Medicare non-facility rate of $95.19.

Which state has the highest median for CPT 99213?

Alaska has the highest median at $161; Alabama has the lowest at $63.

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.

See how your contracts compare for CPT 99213

Benchmark your negotiated rates for 99213 and the rest of your book against these payer and state medians.

Request a rate benchmark