CPT 45380 · professional fee

Colonoscopy and biopsy (CPT 45380): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 45380, from their published in-network rate files.

GastroenterologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$470

P10 to P90: $253 to $952

vs Medicare

264%

facility rate $177.69

Payer spread

2.07×

UHC $727 vs Aetna $351

State spread

4.0×

AK $1,167 to MI $294

4,439 sampled providers5,144 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 45380 in the files analyzed, at $727, 107% above Aetna ($351), the lowest of the 4 payers shown.

The state spread is 4.0×: Alaska has the highest median at $1,167 and Michigan the lowest at $294, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 264% of the Medicare facility rate ($177.69), which ranks 9th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within UnitedHealthcare (interquartile range $382) and widest within Blue Cross Blue Shield ($307).

This is a top-4 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 ($479.97) is 2.7× 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	$727	$563	$945	+55%	1	3,741	409% of Medicare
Blue Cross Blue Shield	$454	$316	$623	-3%	2	3,484	256% of Medicare
Cigna	$417	$329	$551	-11%	3	3,571	235% of Medicare
Aetna	$351	$262	$474	-25%	4	3,196	198% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare facility ($177.69)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$1,167	+148%	n/a	n/a	16
2	Oregon	$1,159	+147%	BCBS	Aetna	104
3	Wisconsin	$842	+79%	UHC	Cigna	106
4	Nebraska	$721	+53%	UHC	Cigna	46
5	Vermont	$650	+38%	BCBS	UHC	23
6	Minnesota	$650	+38%	UHC	Aetna	90
7	North Carolina	$639	+36%	UHC	Aetna	124
8	Connecticut	$623	+33%	UHC	Aetna	122
9	Mississippi	$603	+28%	UHC	Cigna	92
10	Washington	$594	+26%	UHC	Aetna	97
11	Idaho	$593	+26%	UHC	Cigna	52
12	New Hampshire	$585	+24%	UHC	Aetna	74
13	Massachusetts	$573	+22%	UHC	Aetna	113
14	Hawaii	$563	+20%	Cigna	UHC	45
15	Iowa	$538	+14%	UHC	Aetna	56
16	North Dakota	$518	+10%	UHC	BCBS	20
17	District of Columbia	$515	+10%	UHC	BCBS	51
18	New Jersey	$495	+5%	UHC	Aetna	116
18	Georgia	$495	+5%	UHC	Cigna	127
20	Tennessee	$492	+5%	UHC	Aetna	110
21	New York	$484	+3%	UHC	Aetna	131
22	Kansas	$476	+1%	UHC	Aetna	62
23	Pennsylvania	$476	+1%	UHC	Cigna	114
24	Louisiana	$476	+1%	UHC	BCBS	123
25	Utah	$465	-1%	UHC	BCBS	86
26	South Dakota	$455	-3%	UHC	BCBS	25
27	Alabama	$454	-3%	UHC	Cigna	115
28	Indiana	$450	-4%	UHC	Aetna	110
29	South Carolina	$450	-4%	BCBS	Aetna	116
30	Ohio	$450	-4%	UHC	Aetna	123
31	Maryland	$443	-6%	UHC	BCBS	110
32	Kentucky	$434	-8%	UHC	BCBS	123
33	Virginia	$434	-8%	UHC	BCBS	118
34	Arizona	$422	-10%	UHC	BCBS	97
35	Missouri	$420	-11%	UHC	Aetna	135
36	California	$413	-12%	UHC	Aetna	107
37	Delaware	$411	-13%	UHC	Aetna	29
38	Florida	$410	-13%	UHC	Cigna	120
39	New Mexico	$403	-14%	UHC	Aetna	58
40	Illinois	$403	-14%	UHC	Aetna	115
41	West Virginia	$398	-15%	UHC	BCBS	49
42	Rhode Island	$388	-18%	UHC	BCBS	66
43	Arkansas	$387	-18%	UHC	Aetna	81
44	Maine	$377	-20%	UHC	Aetna	53
45	Texas	$376	-20%	UHC	Aetna	132
46	Colorado	$371	-21%	UHC	BCBS	126
47	Oklahoma	$364	-23%	UHC	Aetna	98
48	Nevada	$325	-31%	UHC	Aetna	84
49	Montana	$311	-34%	UHC	BCBS	28
50	Michigan	$294	-38%	UHC	Aetna	113

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 45380?

In the files we analyzed, UnitedHealthcare, at a median of $727 across 3,741 sampled providers. Aetna is lowest at $351, 107% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 264% of the 2026 Medicare facility rate of $177.69.

Which state has the highest median for CPT 45380?

Alaska has the highest median at $1,167; Michigan has the lowest at $294.

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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