CPT 99215 · professional fee

Office o/p est hi 40 min (CPT 99215): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 99215, from their published in-network rate files.

Cardiology UrologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$176

P10 to P90: $118 to $329

vs Medicare

91%

non-facility rate $192.39

Payer spread

1.52×

UHC $209 vs Aetna $138

State spread

2.9×

AK $352 to AL $122

39,061 sampled providers35,955 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 99215 in the files analyzed, at $209, 52% above Aetna ($138), the lowest of the 4 payers shown.

The state spread is 2.9×: Alaska has the highest median at $352 and Alabama the lowest at $122, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 91% of the Medicare non-facility rate ($192.39), which ranks 214th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $48) and widest within UnitedHealthcare ($129).

This is a top-4 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	$209	$153	$282	+19%	1	31,635	109% of Medicare
Cigna	$186	$141	$241	+6%	2	31,293	97% of Medicare
Blue Cross Blue Shield	$183	$147	$238	+4%	3	30,334	95% of Medicare
Aetna	$138	$123	$171	-22%	4	25,811	72% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($192.39)

Rates by state

Median across payers · 51 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$352	+100%	UHC	Cigna	328
2	Oregon	$294	+67%	UHC	Aetna	808
3	Wisconsin	$291	+65%	UHC	Aetna	867
4	Washington	$276	+57%	UHC	Aetna	868
5	Nebraska	$265	+51%	UHC	Aetna	601
6	Massachusetts	$264	+50%	UHC	Aetna	920
7	Wyoming	$249	+42%	BCBS	Aetna	270
8	Hawaii	$230	+31%	Cigna	Aetna	501
9	Montana	$226	+28%	UHC	Aetna	447
10	District of Columbia	$224	+28%	UHC	Aetna	520
11	North Dakota	$223	+27%	BCBS	Aetna	342
12	New Hampshire	$218	+24%	UHC	Aetna	732
13	Idaho	$213	+21%	Cigna	Aetna	616
14	Minnesota	$213	+21%	BCBS	Aetna	851
15	South Dakota	$212	+20%	UHC	Aetna	473
16	Colorado	$208	+18%	UHC	Aetna	944
17	North Carolina	$205	+16%	UHC	Aetna	1,007
17	Georgia	$205	+16%	UHC	Aetna	976
19	Iowa	$199	+13%	UHC	Aetna	712
20	Maine	$197	+12%	UHC	Aetna	647
21	Vermont	$189	+8%	UHC	Aetna	340
22	Connecticut	$187	+6%	UHC	Aetna	933
23	Illinois	$176	+0%	UHC	Aetna	882
24	Ohio	$176	+0%	UHC	Aetna	935
25	New Mexico	$173	-1%	UHC	Aetna	620
26	Oklahoma	$173	-2%	BCBS	Aetna	836
27	Pennsylvania	$173	-2%	UHC	Aetna	881
28	Virginia	$169	-4%	UHC	Aetna	900
29	New York	$169	-4%	UHC	Aetna	939
30	Tennessee	$169	-4%	UHC	Aetna	940
31	Utah	$168	-4%	UHC	Aetna	817
32	New Jersey	$168	-4%	UHC	Aetna	884
33	Kansas	$165	-6%	Cigna	Aetna	790
34	Rhode Island	$165	-6%	UHC	Aetna	632
35	Missouri	$161	-8%	UHC	Aetna	952
36	Delaware	$160	-9%	Cigna	Aetna	458
37	West Virginia	$159	-10%	UHC	BCBS	607
38	Maryland	$157	-11%	UHC	BCBS	847
39	Michigan	$155	-12%	Cigna	Aetna	868
40	South Carolina	$153	-13%	BCBS	Aetna	862
41	Kentucky	$152	-13%	UHC	Aetna	976
42	California	$152	-13%	UHC	BCBS	844
43	Texas	$148	-16%	UHC	BCBS	1,020
43	Indiana	$148	-16%	UHC	Aetna	962
45	Arkansas	$147	-16%	UHC	Aetna	786
46	Florida	$146	-17%	UHC	Aetna	889
47	Nevada	$145	-17%	UHC	Aetna	776
48	Louisiana	$144	-18%	UHC	Aetna	914
49	Mississippi	$142	-19%	BCBS	Aetna	777
50	Arizona	$137	-22%	UHC	BCBS	814
51	Alabama	$122	-31%	UHC	Aetna	950

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 99215?

In the files we analyzed, UnitedHealthcare, at a median of $209 across 31,635 sampled providers. Aetna is lowest at $138, 52% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 91% of the 2026 Medicare non-facility rate of $192.39.

Which state has the highest median for CPT 99215?

Alaska has the highest median at $352; Alabama has the lowest at $122.

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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