CPT 45378 · professional fee

Diagnostic colonoscopy (CPT 45378): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 45378, from their published in-network rate files.

GastroenterologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$408

P10 to P90: $229 to $804

vs Medicare

248%

facility rate $164.67

Payer spread

1.86×

UHC $581 vs Aetna $312

State spread

3.8×

AK $1,021 to MI $272

4,443 sampled providers5,186 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 45378 in the files analyzed, at $581, 86% above Aetna ($312), the lowest of the 4 payers shown.

The state spread is 3.8×: Alaska has the highest median at $1,021 and Michigan the lowest at $272, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 248% of the Medicare facility rate ($164.67), which ranks 14th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Cigna (interquartile range $191) and widest within Blue Cross Blue Shield ($266).

This is a top-12 code for gastroenterology by Medicare allowed dollars, so it carries real revenue weight for that specialty.

The Medicare comparison uses the facility rate: the non-facility rate ($378.10) is 2.3× higher because it includes device or supply cost that professional-fee contracts do not.

Rates by payer

Median of per-provider median rates, with interquartile range

Payer	Median	P25	P75	vs national	Rank	Providers	Position
UnitedHealthcare	$581	$458	$779	+42%	1	3,746	353% of Medicare
Blue Cross Blue Shield	$404	$290	$556	-1%	2	3,510	246% of Medicare
Cigna	$363	$292	$483	-11%	3	3,571	221% of Medicare
Aetna	$312	$233	$405	-23%	4	3,184	190% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare facility ($164.67)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$1,021	+150%	n/a	n/a	16
2	Oregon	$916	+125%	BCBS	Aetna	104
3	Wisconsin	$777	+91%	UHC	Aetna	106
4	North Dakota	$586	+44%	BCBS	UHC	20
5	Nebraska	$571	+40%	UHC	BCBS	46
6	Minnesota	$568	+39%	UHC	Aetna	91
7	Connecticut	$556	+36%	UHC	Aetna	122
8	Vermont	$550	+35%	BCBS	UHC	23
9	Mississippi	$536	+31%	BCBS	Cigna	92
10	Idaho	$526	+29%	UHC	Cigna	52
11	New Hampshire	$514	+26%	UHC	Aetna	74
12	North Carolina	$513	+26%	BCBS	Aetna	124
13	Washington	$498	+22%	UHC	Aetna	97
14	District of Columbia	$494	+21%	UHC	BCBS	51
15	Massachusetts	$483	+19%	UHC	Aetna	113
16	Iowa	$459	+13%	UHC	Aetna	56
17	Georgia	$456	+12%	UHC	Aetna	127
18	Hawaii	$441	+8%	Cigna	UHC	45
19	New Jersey	$439	+8%	UHC	Aetna	116
20	New York	$426	+4%	UHC	Aetna	131
21	Tennessee	$425	+4%	UHC	Aetna	110
22	Pennsylvania	$421	+3%	UHC	Cigna	115
23	South Dakota	$420	+3%	UHC	BCBS	25
24	Alabama	$408	+0%	BCBS	Cigna	115
24	South Carolina	$408	+0%	BCBS	Aetna	116
26	Kansas	$408	+0%	UHC	Aetna	62
27	Utah	$389	-5%	UHC	Cigna	86
28	Louisiana	$380	-7%	UHC	BCBS	123
29	Maryland	$378	-7%	UHC	BCBS	110
30	Ohio	$376	-8%	UHC	Cigna	123
31	Illinois	$372	-9%	UHC	Aetna	115
32	Missouri	$371	-9%	UHC	Aetna	135
33	Virginia	$362	-11%	UHC	BCBS	118
34	Kentucky	$360	-12%	UHC	BCBS	124
35	Indiana	$359	-12%	UHC	Aetna	110
36	California	$358	-12%	UHC	Aetna	108
37	Florida	$357	-12%	UHC	Cigna	120
38	Arizona	$352	-14%	UHC	BCBS	97
39	New Mexico	$349	-15%	UHC	Aetna	58
40	Maine	$337	-17%	UHC	Aetna	53
41	Arkansas	$333	-18%	UHC	Aetna	81
42	West Virginia	$332	-19%	UHC	BCBS	49
43	Delaware	$329	-19%	UHC	Cigna	29
44	Rhode Island	$321	-21%	UHC	Aetna	66
45	Colorado	$316	-23%	UHC	Aetna	126
46	Oklahoma	$314	-23%	UHC	Aetna	98
47	Texas	$309	-24%	UHC	Aetna	132
48	Nevada	$298	-27%	UHC	Aetna	84
49	Montana	$287	-30%	UHC	Cigna	28
50	Michigan	$272	-33%	UHC	Aetna	113

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 45378?

In the files we analyzed, UnitedHealthcare, at a median of $581 across 3,746 sampled providers. Aetna is lowest at $312, 86% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 248% of the 2026 Medicare facility rate of $164.67.

Which state has the highest median for CPT 45378?

Alaska has the highest median at $1,021; Michigan has the lowest at $272.

Is this the surgeon, physician or facility payment?

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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