Urology · specialty benchmark

Urology commercial reimbursement benchmarks

What commercial payers pay for the procedures that matter most to urology practices.

Urology at a glance

4,265 sampled providers

Codes tracked

publishable codes

Median % of Medicare

157%

across codes

Highest state

Alaska

Highest payer

UHC

UnitedHealthcare

Urology rates in this dataset cover 37 procedure codes and 4,265 sampled providers in 51 states, at a median 157% of Medicare.

Alaska has the highest urology index and Oklahoma the lowest.

UnitedHealthcare has the highest urology index and Aetna the lowest.

The biggest revenue code by Medicare allowed dollars is CPT 99214 (Office o/p est mod 30 min), paid at a 134-dollar median, 99% of Medicare.

Ranked by Medicare allowed dollars billed by the specialty

Rank	Code	Median	Medicare	% of Medicare	Providers
1	CPT 99214 Office o/p est mod 30 min	$134	$135.61	99%	4,247
2	CPT 99213 Office o/p est low 20 min	$92	$95.19	97%	4,247
3	CPT 52000 Cystourethroscopy	$210	$71.14	296%	4,227
4	CPT 99204 Office o/p new mod 45 min	$197	$177.36	111%	4,246
5	CPT 99215 Office o/p est hi 40 min	$187	$192.39	97%	4,245
6	CPT 52356 Cysto/uretero w/lithotripsy	$657	$365.07	180%	4,227
7	CPT 99490 Chrnc care mgmt staff 1st 20	$60	$66.13	91%	4,195
8	CPT 51728 Cystometrogram w/vp	$520	$336.68	154%	4,210
9	CPT 99203 Office o/p new low 30 min	$125	$117.57	106%	4,246
10	CPT 76872 Us transrectal	$188	$120.24	157%	4,206

Index: 100 = four-payer median for the specialty's codes

Payer	Index	Rank	Highest on
UnitedHealthcare	121	1	81%
Cigna	103	2	16%
Blue Cross Blue Shield	97	3	3%
Aetna	76	4	0%

Index: 100 = the specialty's national median

Rank	State	Index	Codes	Providers
1	Alaska	207	37	22
2	Wisconsin	166	37	114
3	Oregon	163	37	105
4	Washington	134	37	111
5	District of Columbia	131	37	49
6	Nebraska	128	37	50
7	New Hampshire	127	37	51
8	North Dakota	120	37	21
9	Minnesota	119	37	112
9	North Carolina	119	37	123
11	Georgia	118	37	118
12	South Dakota	116	37	34
13	Connecticut	115	37	116
14	New Jersey	114	37	106
15	Massachusetts	110	37	112
16	Hawaii	108	36	29
17	Iowa	108	37	84
18	Mississippi	107	37	67
19	Vermont	106	37	31
20	California	106	37	95
21	Ohio	105	37	112
22	Utah	103	37	76
23	New York	102	37	116
24	Idaho	102	37	46
25	Colorado	102	37	116
26	Pennsylvania	102	37	111
27	Nevada	102	37	57
28	Illinois	98	37	108
29	Maryland	96	37	104
30	Virginia	96	37	109
31	Montana	96	37	39
32	South Carolina	95	37	101
33	Rhode Island	93	37	41
34	Missouri	92	37	119
35	West Virginia	92	37	49
36	Maine	91	37	48
37	New Mexico	91	37	34
38	Tennessee	91	37	110
39	Kentucky	91	37	116
40	Arkansas	90	37	67
41	Kansas	87	37	93
42	Delaware	87	37	29
43	Florida	86	37	112
44	Indiana	86	37	124
45	Michigan	84	37	113
46	Louisiana	83	37	104
47	Arizona	83	37	100
48	Alabama	80	37	117
49	Texas	80	37	124
50	Oklahoma	77	37	108

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 negotiated rates compare by code, payer and state.