CPT 45384 · professional fee

Colonoscopy w/lesion removal (CPT 45384): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 45384, from their published in-network rate files.

GastroenterologySnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$519

P10 to P90: $273 to $1,077

vs Medicare

255%

facility rate $203.41

Payer spread

2.24×

UHC $801 vs Aetna $357

State spread

4.9×

OR $1,533 to MI $314

4,422 sampled providers5,093 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 45384 in the files analyzed, at $801, 124% above Aetna ($357), the lowest of the 4 payers shown.

The state spread is 4.9×: Oregon has the highest median at $1,533 and Michigan the lowest at $314, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 255% of the Medicare facility rate ($203.41), which ranks 13th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Cigna (interquartile range $230) and widest within Blue Cross Blue Shield ($363).

This is a top-34 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 ($539.42) is 2.6× 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	$801	$610	$1,067	+54%	1	3,742	394% of Medicare
Blue Cross Blue Shield	$501	$334	$697	-4%	2	3,502	246% of Medicare
Cigna	$437	$360	$590	-16%	3	3,574	215% of Medicare
Aetna	$357	$258	$507	-31%	4	2,263	176% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare facility ($203.41)

Rates by state

Median across payers · 50 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Oregon	$1,533	+195%	BCBS	Cigna	104
2	Alaska	$1,056	+103%	n/a	n/a	16
3	Wisconsin	$965	+86%	UHC	Cigna	106
4	Nebraska	$807	+55%	UHC	Cigna	46
5	North Carolina	$718	+38%	UHC	Aetna	124
6	Minnesota	$717	+38%	UHC	Aetna	90
7	Connecticut	$709	+36%	UHC	Aetna	121
8	New Hampshire	$694	+34%	UHC	Aetna	72
9	Vermont	$675	+30%	BCBS	Cigna	23
10	Washington	$668	+29%	UHC	Aetna	95
11	Mississippi	$653	+26%	BCBS	Cigna	92
12	Massachusetts	$638	+23%	UHC	Aetna	113
13	Idaho	$631	+22%	UHC	Cigna	52
13	Hawaii	$631	+22%	UHC	Cigna	45
15	Georgia	$599	+15%	UHC	Cigna	125
16	North Dakota	$589	+13%	UHC	BCBS	20
17	Iowa	$554	+7%	UHC	BCBS	56
18	Tennessee	$550	+6%	UHC	Aetna	108
19	New York	$540	+4%	UHC	Aetna	131
20	District of Columbia	$537	+3%	UHC	BCBS	51
21	New Jersey	$534	+3%	UHC	Aetna	116
22	Kansas	$524	+1%	UHC	Aetna	62
23	South Dakota	$519	+0%	UHC	BCBS	25
24	Alabama	$510	-2%	UHC	Cigna	115
25	South Carolina	$504	-3%	BCBS	Aetna	114
26	Maryland	$489	-6%	UHC	BCBS	110
27	Missouri	$486	-6%	UHC	Aetna	135
28	Virginia	$483	-7%	UHC	BCBS	117
29	Ohio	$482	-7%	UHC	BCBS	123
30	Utah	$476	-8%	UHC	Cigna	87
31	Indiana	$475	-8%	UHC	Aetna	110
32	Louisiana	$470	-10%	UHC	BCBS	119
33	Rhode Island	$468	-10%	UHC	BCBS	66
34	Pennsylvania	$467	-10%	UHC	Aetna	114
35	Illinois	$467	-10%	UHC	Aetna	115
36	Delaware	$452	-13%	UHC	Cigna	29
37	Arizona	$450	-13%	UHC	BCBS	98
38	Kentucky	$448	-14%	UHC	Aetna	124
39	Florida	$442	-15%	UHC	Cigna	120
40	West Virginia	$441	-15%	UHC	Aetna	49
41	Maine	$439	-16%	UHC	Aetna	53
42	New Mexico	$436	-16%	UHC	Aetna	58
43	California	$435	-16%	UHC	Aetna	107
44	Colorado	$431	-17%	UHC	Aetna	124
45	Arkansas	$411	-21%	UHC	Aetna	81
46	Oklahoma	$396	-24%	UHC	Aetna	98
47	Texas	$377	-28%	UHC	Aetna	132
48	Nevada	$367	-29%	UHC	Aetna	84
49	Montana	$354	-32%	UHC	BCBS	28
50	Michigan	$314	-39%	UHC	Aetna	111

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 45384?

In the files we analyzed, UnitedHealthcare, at a median of $801 across 3,742 sampled providers. Aetna is lowest at $357, 124% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 255% of the 2026 Medicare facility rate of $203.41.

Which state has the highest median for CPT 45384?

Oregon has the highest median at $1,533; Michigan has the lowest at $314.

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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