CPT 99426 · professional fee

Prin care mgmt staff 1st 30 (CPT 99426): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 99426, from their published in-network rate files.

UrologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$77

P10 to P90: $48 to $138

vs Medicare

113%

non-facility rate $67.80

Payer spread

1.93×

UHC $95 vs Aetna $49

State spread

3.4×

AK $167 to AL $49

4,163 sampled providers4,531 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 99426 in the files analyzed, at $95, 93% above Aetna ($49), the lowest of the 4 payers shown.

The state spread is 3.4×: Alaska has the highest median at $167 and Alabama the lowest at $49, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 113% of the Medicare non-facility rate ($67.80), which ranks 174th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $12) and widest within Blue Cross Blue Shield ($40).

This is a top-24 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	$95	$78	$126	+24%	1	3,584	140% of Medicare
Cigna	$78	$63	$97	+1%	2	3,348	115% of Medicare
Blue Cross Blue Shield	$66	$53	$93	-14%	3	3,118	98% of Medicare
Aetna	$49	$45	$57	-36%	4	1,506	72% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($67.80)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$167	+118%	n/a	n/a	22
2	Oregon	$134	+75%	UHC	BCBS	101
3	Wisconsin	$127	+66%	UHC	Aetna	113
4	North Dakota	$117	+53%	n/a	n/a	21
5	New Hampshire	$105	+37%	UHC	Cigna	50
6	Washington	$104	+36%	UHC	Aetna	111
7	Nebraska	$103	+35%	UHC	BCBS	49
8	Minnesota	$94	+23%	UHC	Aetna	110
9	Georgia	$92	+19%	UHC	BCBS	118
10	Massachusetts	$91	+19%	UHC	Aetna	102
11	Maine	$90	+18%	UHC	BCBS	48
12	South Dakota	$90	+18%	UHC	BCBS	33
13	District of Columbia	$89	+16%	UHC	BCBS	47
14	California	$89	+16%	UHC	Aetna	95
15	New Jersey	$89	+16%	UHC	Aetna	104
16	Vermont	$88	+15%	UHC	BCBS	29
16	Colorado	$88	+15%	UHC	Aetna	114
18	Connecticut	$86	+12%	UHC	Aetna	114
19	Nevada	$84	+9%	UHC	BCBS	54
20	Ohio	$83	+8%	UHC	Aetna	111
21	North Carolina	$83	+8%	UHC	BCBS	105
22	Hawaii	$81	+6%	Cigna	UHC	27
23	Idaho	$81	+6%	UHC	Aetna	46
24	Pennsylvania	$80	+5%	UHC	Aetna	108
25	New Mexico	$79	+3%	UHC	BCBS	33
26	New York	$78	+2%	UHC	Aetna	115
27	Montana	$77	+1%	UHC	BCBS	39
28	Illinois	$77	-0%	UHC	BCBS	107
29	Maryland	$76	-1%	UHC	Aetna	101
30	West Virginia	$76	-1%	UHC	BCBS	48
31	Utah	$76	-1%	UHC	BCBS	76
32	Virginia	$74	-3%	UHC	Aetna	103
33	Delaware	$74	-4%	UHC	Aetna	29
34	Florida	$74	-4%	UHC	Aetna	111
35	South Carolina	$73	-5%	UHC	Aetna	97
36	Iowa	$71	-7%	UHC	Aetna	82
37	Arkansas	$71	-7%	UHC	Aetna	64
38	Missouri	$71	-8%	UHC	Aetna	118
39	Oklahoma	$69	-10%	UHC	Aetna	108
40	Tennessee	$69	-10%	UHC	Aetna	106
41	Kansas	$69	-11%	UHC	Aetna	86
42	Arizona	$68	-11%	UHC	Aetna	99
43	Michigan	$68	-11%	UHC	Aetna	109
44	Texas	$66	-14%	UHC	BCBS	124
45	Mississippi	$63	-17%	UHC	Cigna	66
46	Rhode Island	$63	-18%	UHC	Aetna	40
47	Kentucky	$62	-19%	UHC	BCBS	116
48	Louisiana	$62	-19%	UHC	BCBS	102
49	Indiana	$61	-21%	UHC	BCBS	124
50	Alabama	$49	-36%	UHC	Aetna	116

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 99426?

In the files we analyzed, UnitedHealthcare, at a median of $95 across 3,584 sampled providers. Aetna is lowest at $49, 93% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 113% of the 2026 Medicare non-facility rate of $67.80.

Which state has the highest median for CPT 99426?

Alaska has the highest median at $167; Alabama has the lowest at $49.

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 99426

Benchmark your negotiated rates for 99426 and the rest of your book against these payer and state medians.

Request a rate benchmark