CPT 45385 · professional fee

Colonoscopy w/lesion removal (CPT 45385): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 45385, from their published in-network rate files.

Gastroenterology Internal medicineSnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$549

P10 to P90: $306 to $1,074

vs Medicare

246%

facility rate $223.45

Payer spread

1.91×

UHC $778 vs Aetna $408

State spread

3.1×

AK $1,131 to MI $369

9,888 sampled providers11,032 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 45385 in the files analyzed, at $778, 91% above Aetna ($408), the lowest of the 4 payers shown.

The state spread is 3.1×: Alaska has the highest median at $1,131 and Michigan the lowest at $369, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 246% of the Medicare facility rate ($223.45), which ranks 17th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Cigna (interquartile range $248) and widest within Blue Cross Blue Shield ($351).

This is the #1 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 ($500.01) is 2.2× 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	$778	$595	$1,058	+42%	1	7,989	348% of Medicare
Blue Cross Blue Shield	$549	$387	$738	+0%	2	7,576	246% of Medicare
Cigna	$485	$394	$642	-12%	3	7,710	217% of Medicare
Aetna	$408	$308	$524	-26%	4	6,115	183% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare facility ($223.45)

Rates by state

Median across payers · 51 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$1,131	+106%	Aetna	Cigna	106
2	Wisconsin	$1,044	+90%	UHC	Aetna	208
3	Wyoming	$809	+47%	BCBS	Aetna	113
4	Nebraska	$789	+44%	UHC	Aetna	135
5	Minnesota	$777	+42%	UHC	Aetna	203
6	Connecticut	$758	+38%	UHC	Aetna	240
7	Oregon	$737	+34%	UHC	Aetna	203
8	Vermont	$733	+34%	UHC	Aetna	129
9	Mississippi	$704	+28%	BCBS	Aetna	193
10	North Carolina	$693	+26%	BCBS	Aetna	248
11	New Hampshire	$669	+22%	UHC	Aetna	184
12	Washington	$661	+20%	UHC	Aetna	206
13	Massachusetts	$640	+17%	UHC	Aetna	232
14	North Dakota	$639	+16%	UHC	Aetna	128
15	Georgia	$616	+12%	UHC	Aetna	247
16	South Dakota	$598	+9%	UHC	Aetna	148
17	Iowa	$586	+7%	UHC	Aetna	155
18	Idaho	$585	+7%	UHC	Cigna	160
19	Hawaii	$584	+7%	UHC	Aetna	119
20	District of Columbia	$579	+5%	UHC	BCBS	134
21	Kansas	$578	+5%	UHC	Aetna	172
22	South Carolina	$556	+1%	BCBS	Aetna	215
23	Utah	$552	+1%	UHC	Cigna	194
24	New York	$551	+0%	UHC	Aetna	245
25	Louisiana	$524	-4%	UHC	BCBS	235
26	Tennessee	$516	-6%	UHC	Aetna	217
27	Pennsylvania	$511	-7%	UHC	Cigna	222
28	New Jersey	$510	-7%	UHC	Aetna	229
29	Alabama	$509	-7%	BCBS	Cigna	218
30	Missouri	$508	-7%	UHC	Aetna	249
31	Illinois	$506	-8%	UHC	Aetna	201
32	Indiana	$503	-8%	UHC	Aetna	233
33	Ohio	$502	-8%	UHC	Cigna	243
34	California	$481	-12%	UHC	Aetna	203
35	Maine	$475	-13%	UHC	Aetna	173
36	Rhode Island	$474	-14%	UHC	Aetna	164
37	Kentucky	$473	-14%	UHC	BCBS	251
38	New Mexico	$465	-15%	UHC	Aetna	162
39	Arizona	$461	-16%	UHC	BCBS	193
40	Arkansas	$460	-16%	UHC	Aetna	201
41	Virginia	$459	-16%	UHC	BCBS	215
42	West Virginia	$458	-16%	UHC	Aetna	163
43	Colorado	$452	-18%	UHC	Aetna	241
44	Maryland	$447	-18%	UHC	BCBS	204
45	Florida	$438	-20%	UHC	Cigna	221
46	Oklahoma	$433	-21%	UHC	Aetna	207
47	Texas	$410	-25%	UHC	Aetna	252
48	Delaware	$409	-25%	UHC	Aetna	136
49	Nevada	$400	-27%	UHC	Aetna	190
50	Montana	$394	-28%	UHC	Cigna	131
51	Michigan	$369	-33%	UHC	Aetna	217

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 45385?

In the files we analyzed, UnitedHealthcare, at a median of $778 across 7,989 sampled providers. Aetna is lowest at $408, 91% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 246% of the 2026 Medicare facility rate of $223.45.

Which state has the highest median for CPT 45385?

Alaska has the highest median at $1,131; Michigan has the lowest at $369.

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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