CPT 99214 · professional fee

Office o/p est mod 30 min (CPT 99214): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 99214, from their published in-network rate files.

Cardiology Internal medicineSnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$125

P10 to P90: $83 to $232

vs Medicare

92%

non-facility rate $135.61

Payer spread

1.55×

UHC $154 vs Aetna $99

State spread

2.5×

AK $237 to AL $95

39,087 sampled providers36,032 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 99214 in the files analyzed, at $154, 55% above Aetna ($99), the lowest of the 4 payers shown.

The state spread is 2.5×: Alaska has the highest median at $237 and Alabama the lowest at $95, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 92% of the Medicare non-facility rate ($135.61), which ranks 213th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $32) and widest within UnitedHealthcare ($95).

This is the #1 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	$154	$113	$208	+23%	1	31,635	114% of Medicare
Cigna	$132	$98	$168	+5%	2	31,293	97% of Medicare
Blue Cross Blue Shield	$129	$104	$169	+3%	3	30,342	95% of Medicare
Aetna	$99	$88	$121	-21%	4	26,613	73% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($135.61)

Rates by state

Median across payers · 51 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$237	+89%	UHC	Cigna	328
2	Wisconsin	$208	+66%	UHC	Aetna	867
3	Oregon	$205	+64%	UHC	Aetna	808
4	Washington	$191	+53%	UHC	Aetna	868
5	Nebraska	$186	+49%	UHC	Aetna	601
6	Massachusetts	$182	+45%	UHC	Aetna	920
7	Wyoming	$173	+38%	UHC	Aetna	270
8	Hawaii	$165	+32%	Cigna	Aetna	502
9	New Hampshire	$158	+27%	UHC	Aetna	732
10	North Dakota	$156	+24%	BCBS	Aetna	342
11	Minnesota	$153	+23%	BCBS	Aetna	851
12	Montana	$152	+21%	UHC	Aetna	447
13	South Dakota	$150	+20%	UHC	Aetna	473
14	District of Columbia	$150	+20%	UHC	BCBS	520
15	Georgia	$146	+16%	UHC	Aetna	978
16	Colorado	$145	+16%	UHC	Aetna	944
17	Idaho	$144	+15%	Cigna	Aetna	616
18	North Carolina	$143	+15%	UHC	Aetna	1,009
19	Maine	$141	+13%	UHC	Aetna	647
20	Iowa	$141	+12%	UHC	Aetna	712
21	Vermont	$136	+8%	UHC	Aetna	340
22	Connecticut	$134	+7%	UHC	Aetna	933
23	Illinois	$125	+0%	UHC	Aetna	883
24	Ohio	$125	-0%	UHC	Aetna	935
25	New Mexico	$124	-1%	UHC	Aetna	621
26	Pennsylvania	$123	-2%	UHC	Aetna	884
26	Oklahoma	$123	-2%	BCBS	Aetna	836
28	Tennessee	$121	-3%	UHC	Aetna	942
29	New Jersey	$120	-4%	UHC	Aetna	884
30	New York	$120	-4%	UHC	Aetna	941
31	Utah	$118	-5%	UHC	Aetna	817
32	Michigan	$116	-7%	Cigna	Aetna	871
33	Virginia	$116	-7%	UHC	Aetna	900
34	Rhode Island	$116	-7%	UHC	Aetna	632
35	Indiana	$115	-8%	BCBS	Aetna	962
36	California	$114	-9%	UHC	Aetna	844
37	Missouri	$114	-9%	UHC	Aetna	952
38	Delaware	$114	-9%	Cigna	Aetna	459
39	Kansas	$112	-10%	Cigna	Aetna	790
40	West Virginia	$110	-12%	UHC	BCBS	607
40	Kentucky	$110	-12%	UHC	Aetna	976
42	South Carolina	$110	-12%	BCBS	Aetna	866
43	Texas	$108	-14%	UHC	BCBS	1,020
44	Maryland	$108	-14%	UHC	BCBS	848
45	Nevada	$107	-14%	UHC	Aetna	776
46	Arkansas	$106	-15%	UHC	Aetna	786
47	Louisiana	$106	-15%	UHC	Aetna	915
48	Florida	$104	-17%	UHC	Aetna	889
49	Mississippi	$103	-18%	BCBS	Aetna	778
50	Arizona	$98	-22%	UHC	Aetna	815
51	Alabama	$95	-24%	UHC	Aetna	950

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 99214?

In the files we analyzed, UnitedHealthcare, at a median of $154 across 31,635 sampled providers. Aetna is lowest at $99, 55% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 92% of the 2026 Medicare non-facility rate of $135.61.

Which state has the highest median for CPT 99214?

Alaska has the highest median at $237; Alabama has the lowest at $95.

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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