What Insurers Pay for Colonoscopy + Biopsy (CPT 45380): 2026 Benchmarks

Part of our payer reimbursement benchmarks series — 17 payers cover 45380, with a national median of $859 and a 5.9× spread between the highest- and lowest-paying payers.

Official CMS descriptor: Colonoscopy and biopsy

MRF vintage2026-Q2
Rates analyzed752
Generated
Billing classInstitutional (Facility)

National benchmarks

Facility fee · national median$859all payers
IQR$821–$90025th–75th pct
Payer Spread5.9×top ÷ bottom payer
State Spread6.5×top ÷ bottom state
Rates Analyzed752from TiC filings

What this number is — and isn’t

This is the facility fee— what the insurer has contracted to pay the hospital or surgery center for this specific billing code, as published in the insurer’s Transparency in Coverage filing. It covers the technical or facility component of the procedure only. Most care episodes generate additional bills: a separate physician fee (billed under the same CPT as a professional claim), anesthesia, and follow-up care — so an all-in episode total is typically several times this line item. This number is not a patient cost estimate; what you owe depends on your deductible, coinsurance, and the other codes billed.

By payer

Negotiated medians by payer

Payer-level negotiated medians for CPT 45380
PayerMedian rateStates covered
Aetna$2,56956
Blue Cross Blue Shield of Wyoming$1,10651
CareFirst BlueCross BlueShield$1,0914
11 more payers between these — medians by payer and state Unlock with Pro →
Blue Cross Blue Shield FEP$70147
Anthem (Elevance)$49135
Blue Cross Blue Shield of North Dakota$43552
Aetna pays a median of $2,569 for 45380 — 5.9× more than Blue Cross Blue Shield of North Dakota at $435. Caveat: percent-of-charge and per-diem contract artifacts can inflate or deflate MRF-derived medians; see methodology.

Payer-level medians are aggregated across all states each payer covers. Filter to your payer and state →

Rates by state

State-level negotiated medians for CPT 45380
StateMedianCoverage
MP$1,868Partial
VI$1,261Partial
WV$975Full
LA$940Full
MA$940Full
All 56 states and territories, including yours Unlock with Pro →

Showing the 5 highest-median states. State medians are computed from payer-level medians; cells with fewer than 5 underlying rates are suppressed.

Methodology

The national median for 45380 is computed using a median-of-state-medians method: within each state we compute the median of all payer-reported in-network rates, then take the median of those state medians. This prevents high-volume states from dominating the national figure.

Cells with fewer than 5 underlying rates are suppressed before aggregation to prevent thin markets from distorting state or national summaries. An institutional billing class means rates reflect the facility fee schedule — what a hospital or ambulatory surgery center bills. The two billing classes are not directly comparable for the same procedure code.

All rates are derived from federally-mandated Transparency in Coverage Machine-Readable Files (45 CFR Part 147). We do not model, estimate, or invent prices — every figure traces back to a payer-published filing. A median is a summary, not a quote. No individual provider necessarily charges the median; percentile ranges exist precisely because prices vary. Verify specifics with your payer or provider. See our full methodology.

Payers contract under different structures (fee schedule, percent of billed charges, case rates); medians that diverge sharply from the national range usually reflect a different payment methodology rather than a genuinely different price.

Cite this data

CareCost Explorer, “Negotiated rate benchmarks for CPT 45380,” 2026-Q2 Transparency in Coverage data, carecostexplorer.com/benchmarks/procedure/45380. Generated 2026-06-12.

Journalists and researchers: this data is free to cite with attribution.

Frequently Asked Questions

What is the average negotiated rate for CPT 45380?

The national median negotiated rate for CPT 45380 (Colonoscopy and biopsy) is $859, computed from 752 rates across 17 payers and 56 states and territories. Individual payer medians range from $435 (Blue Cross Blue Shield of North Dakota) to $2,569 (Aetna). A median is a summary — your actual contracted rate depends on your specific payer and state.

Why do rates for CPT 45380 vary 5.9× between payers?

Negotiated rates are set individually between each payer and each provider network, so payer-level medians reflect different provider mixes, contract vintages, and market leverage. For CPT 45380, the top payer median ($2,569, Aetna) is 5.9× the bottom payer median ($435, Blue Cross Blue Shield of North Dakota). Percent-of-charge and per-diem contract structures can also inflate or deflate MRF-derived figures; see our methodology for details.

What does the institutional rate for CPT 45380 cover?

An institutional rate applies when CPT 45380 is billed under a facility fee schedule — typically by a hospital or ambulatory surgery center, not an individual clinician. The $859 national median reflects the facility component of the procedure. Patients may also receive a separate professional (clinician) bill. The institutional rate is filed under the insurer's facility in-network MRF and is distinct from the professional rate for the same procedure code.

How do I find my payer's rate for CPT 45380 in my state?

CareCost Explorer lets you filter by payer and state to see the specific negotiated median for your market. The data above shows payer-level medians aggregated across all states each payer covers; your state-specific rate may differ. Use the full Explorer tool at carecostexplorer.com/pricing to query your payer and geography directly.
Aetna pays a median of $2,569 for 45380 nationally. See the rate for your state →

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Aetna's median for 45380 is $2,569 — but your state and plan tell a different story. 36M+ rates, queryable.

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