CPT stands for Current Procedural Terminology. It is a standardized set of five-digit codes used by healthcare providers, payers, and facilities to describe medical, surgical, and diagnostic services. These codes are crucial for billing and reimbursement processes, ensuring a consistent understanding of the services rendered across the healthcare system.

How can I find out the cost of a medical procedure?

Finding the exact cost of a medical procedure can be complex due to various factors like your insurance plan, location, and specific provider. You can start by contacting your healthcare provider's billing department for an estimate. For more generalized information or to search for specific CPT code pricing based on your location, you can utilize resources like Payerprice. They offer a fee schedule lookup tool that allows you to search with CPT codes and specific locations to get a better understanding of potential costs.

Why do healthcare prices vary so much?

Healthcare prices can vary significantly due to multiple factors, including geographical location, the type of facility (e.g., hospital vs. outpatient clinic), the specific provider, negotiated rates with different insurance companies, and the complexity of the service. Each provider and payer may have different fee schedules, leading to a wide range of costs for the same service.

Will my insurance cover the full cost of a procedure?

It is unlikely that your insurance will cover the full cost of a procedure without any out-of-pocket expenses. Most insurance plans have deductibles, co-pays, and co-insurance that you are responsible for paying. The extent of coverage also depends on whether the service is considered in-network or out-of-network, and if it's deemed medically necessary. Always contact your insurance provider directly to understand your specific benefits and estimated out-of-pocket costs for any planned procedure.

How can I get an estimate for a specific medical service in my area?

To get an estimate for a specific medical service in your area, you should first obtain the CPT code for the service from your doctor or healthcare provider. Then, you can use online tools specifically designed for price transparency. Payerprice offers a fee schedule lookup tool where you can enter the CPT code and your specific location to find typical prices for that service in your area. Additionally, always confirm with your healthcare provider's billing department for a personalized estimate that considers your specific situation and insurance plan.

CPT 45381 Fee Schedule

Q: Factors that affect fee schedules

Medicare & Medicaid Rates: Government-set reimbursement amounts. Private Insurance Rates: Negotiated rates between providers and insurance companies. Geographic Location: Costs may be higher in urban areas. Provider Type: Hospital providers may have different rates than private practice.

Last Verified: September 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Intestinal Exam (Colonoscopy), An Exam Of The Intestine Using A Scope (Colonoscopy). An Injection Is Given Into The Intestinal Tissues During The Exam.

Key Fact	Detail
Service Type	Surgery Surgical Procedures on the Digestive System
Common Place of Service	24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital
Common Modifiers	None 59 - Distinct Procedural Service PT - Colorectal cancer screening test; converted to diagnostic test or other procedure
Complexity Level	Moderate
Medicare Fee Schedule	View Medicare rates for 45381
Medicaid Fee Schedule	View Medicaid rates for 45381

National average reimbursement for CPT 45381 by major payers:

$553.63

$576.87

$640.50

$362.40

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 45381.

CPT 45381

5 of 25 sample ratesHigher to lower in this preview

Jessica Wachtel
NJInternal Medicine PhysicianNPI 1396011573Tax ID 85-3737205
$905.17Published rate
Paul Foster
Medical Associates Of Englewood PC
NJInternal Medicine PhysicianNPI 1497795413Tax ID 45-2548322
$725.20Published rate
Yingzi Deng
NJInternal Medicine PhysicianNPI 1346689403Tax ID 81-0889110
$442.73Published rate
Diptika Patel
NJInternal Medicine PhysicianNPI 1417949975Tax ID 22-3822149
$322.85Published rate
Noel Ilogu
Noel Ilogu, Md
NJInternal Medicine PhysicianNPI 1518063551Tax ID 22-3638353
$122.27Published rate

Get a free rate benchmark for your specialty.

Choose your state and specialty to build a report from payer-published rates.

Build my free benchmark

Use market rates to prepare your payer proposal.

Rate Benchmarking

Compare your rates with similar providers.

Select a published rate, define comparable providers, and see where that rate falls in your market.

See a sample rate comparison

Payer Contract Negotiation

Draft a fee schedule renegotiation letter.

Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.

See a sample payer proposal

Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

Check published rates for your payer and codes.

Explore state-level rates by specialty

CPT 45381 vs. Other Surgical Procedures on the Digestive System Codes

The CPT 45381 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 45381 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
45335-CPT	Moderate	Exam Left Colon With Scope, Exam Of The Left Side Of The Lower Colon Using A Flexible Scope Inserted Into The Rectum (Sigmoidoscopy). The Procedure Includes An Injection.
45381-CPT	Moderate	Intestinal Exam (Colonoscopy), An Exam Of The Intestine Using A Scope (Colonoscopy). An Injection Is Given Into The Intestinal Tissues During The Exam.
45385-CPT	Moderate	Colonoscopy To Remove Growth, An Exam Of The Intestine Using A Scope (Colonoscopy). The Procedure Includes Removing One Or More Tissue Growths Such As A Tumor Or Polyp.
45390-CPT	Moderate	Colonoscopy, Flexible; Diagnostic, Including Collection Of Specimen(S) By Brushing Or Washing, When Performed, With Endoscopic Mucosal Resection

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45381. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 45381 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

FREE SAMPLE MARKET COMPARISON

Let's review your payer contracts side-by-side with the market.

Bring your top codes (like CPT 45381) and we'll show you how you compare in 15 minutes or less.

Schedule a Demo

CPT 45381 Fee Schedule

Compare published rates across providers.

Jessica Wachtel

Paul Foster

Yingzi Deng

Diptika Patel

Noel Ilogu