Colon & Rectal Surgery reimbursement rates by service line
Compare payer-published colon & rectal surgery benchmarks for endoscopy; anorectal procedures; colorectal surgery; office visits.
Compare national colon & rectal surgery rates by payer
Use the reference codes to compare payer benchmarks, then explore endoscopy; anorectal procedures; colorectal surgery; office visits. Each rate represents a specific billing code and comparison cohort, rather than a complete episode of care.
Aetna state variation for 45385
National 45385 rate distribution
Each marker shows the national median published rate across billing entities for that payer.
National 45385 rates by payer
| Payer | Rate period | Provider entities | P25 | Median | P75 | P90 | Average |
|---|---|---|---|---|---|---|---|
| Aetna | Jun–Jul 2026 | 2,892 | $512.70 | $588.71 | |||
| Cigna | Jun–Jul 2026 | 2,936 | $615.33 | $711.56 | |||
| United | Jun–Jul 2026 | 3,134 | $833.27 | $928.41 | |||
| Anthem | Jun–Jul 2026 | 2,291 | $652.54 | $838.88 |
- Source
- Negotiated or fee-schedule amounts published directly by payers in their machine-readable files.
- Rate shown
- Published commercial rate for colonoscopy with lesion removal by snare (45385).
- Method
- Eligible rates are grouped by payer and billing entity so the benchmarks use a consistent service and billing basis.
The state map uses one consistent Aetna reference series; it does not average already-aggregated payer values. The service-line table keeps unlike codes, settings, and billing units in separate comparisons.
How do specific colon & rectal surgery providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
National: Colon & Rectal Surgery provider benchmarks (CPT 45385)
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|---|---|---|---|---|
| SPINE CAPITAL LLCNPI 1124078662 · Tax ID 852769769 | WI | 4 | $322.11 | -$190.60 | Below P25 |
| CHARLESTON AREA MEDICAL CENTER INCNPI 1134215973 · Tax ID 550526150 | WV | 2,116 | $383 | -$129.70 | Below P25 |
| MATHEW ISHO MD PCNPI 1841235645 · Tax ID 262284634 | CA | 601 | $442.53 | -$70.18 | P25 to median |
| PROMEDICA CENTRAL PHYSICIANS LLCNPI 1790788644 · Tax ID 341881137 | OH | 2,185 | Median to P75 | ||
| HOSPITAL OF CENTRAL CONNECTICUT AT NEW BRITAIN GENERAL AND BRADLEY MENPI 1760877625 · Tax ID 060646768 | CT | 1,122 | Median to P75 | ||
| WAUKESHA SURGICAL SPECIALISTS SCNPI 1841369832 · Tax ID 391228742 | WI | 30 | Above P75 |
Choose one state to replace the mixed-state examples with payer-specific provider rates across all three preview codes.
No trial or data preparation required.Explore colon & rectal surgery services
Compare codes within the same billing context. A reported billing unit may describe a timed service, supply quantity, daily service or procedure; it does not always mean one visit.
| Service line / billing code | Aetna | Cigna | United | Anthem |
|---|---|---|---|---|
$ per reported billing unit · 11 codes | ||||
45385Colonoscopy with lesion removal by snare | $588.71 | $711.56 | $928.41 | $838.88 |
45380Colonoscopy with biopsy | $524.78 | $631.11 | $873.85 | $728.14 |
46500Injection of sclerosing solution for hemorrhoids | $342.13 | $444.51 | $583.43 | $489.56 |
46221Hemorrhoid banding | $364.70 | $455.04 | $554.29 | $518.94 |
46600Rectal Exam With Scope | $114.88 | $148.65 | $211.72 | $175.07 |
44207Laparoscopic partial colectomy with anastomosis | $2,807.96 | $3,432.34 | $3,666.38 | $3,937.79 |
43239Upper GI endoscopy with biopsy | $415.32 | $498.73 | $751.46 | $666.14 |
45300Scope Exam Of Large Intestine | $139.50 | $176.53 | $249.79 | $210.21 |
44205Colon Removal With Scope | $2,075.81 | $2,537.52 | $2,702.80 | $2,871.77 |
44204Scope Surgery To Remove Colon | $2,376.74 | $2,925.56 | $3,110.49 | $3,297.09 |
44625Closure Of Enterostomy Large | $1,585.06 | $1,914.46 | $2,046.04 | $2,135.52 |
$ per reported billing unit · 7 codes | ||||
99204New patient office visit, level 4 | $188.48 | $250.49 | $282.98 | $270.75 |
99213Established patient office visit, level 3 | $89.49 | $119.40 | $133.05 | $126.62 |
99214Established patient office visit, level 4 | $131 | $174.30 | $192.15 | $181.31 |
99203New patient office visit, level 3 | $121.24 | $161.50 | $186.59 | $177.17 |
99232Subsequent hospital inpatient or observation care, level 2 | $93.03 | $124.11 | $126.09 | $131.44 |
99205New patient office visit, level 5 | $245.93 | $327 | $360.79 | $349.09 |
99222Initial hospital inpatient or observation care, level 2 | $162.11 | $219.94 | $231.75 | $240.30 |
$ per reported billing unit · 1 code | ||||
88305Surgical pathology, gross and microscopic examination | $96.37 | $86.27 | $88.64 | $154.83 |
Tell us the services, payers, states, and networks you need. We'll confirm available coverage and scope the comparison on a 20-minute call.
Book a 20-min scoping call No trial or data preparation required.How to interpret these benchmarks
Payer-published rates provide market context. They do not establish a practice's contracted rate or the total cost of care.
- Source and periodRates come from the specialty's national report. The displayed period follows the processed data included in the latest published snapshot and updates when that snapshot is refreshed.
- Comparable ratesComparisons use positive professional fee-for-service negotiated and fee-schedule dollar amounts. Percentages, bundled arrangements and per-diem rate types are excluded. Modifier cohorts and code-specific amounts remain separate.
- CalculationRates are reduced to one modal value per NPI and TIN entity, averaging tied modes. Two percent per tail is targeted for trimming while keeping boundary ties. Benchmarks require at least 10 included entities and are not weighted by patient volume.
- CoverageNational report coverage does not guarantee every payer or state is available for every code. Anthem represents the displayed Anthem cohort, rather than all regional Blue plans. Missing benchmarks are not zero rates.
- Billing contextMatch the exact code, billing unit, modifier, setting and network. Equipment rentals and supplies require their own interval and quantity checks. Professional rates exclude facility charges; anesthesia conversion factors are outside these comparisons.
Get the colon & rectal surgery reimbursement data you're looking for
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We'll tell you what the data can support, where the gaps are, and the clearest way to structure the comparison.
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Explore colon & rectal surgery rates by state
Choose a state to compare payer reference averages for common services.
Questions about colon & rectal surgery benchmarks
How to interpret the selected market and payer-published rates.
What does the national benchmark compare?
The headline uses Colonoscopy with lesion removal by snare (45385). The other reference codes and service lines provide separate comparisons rather than combining unlike services.
Why is a payer or state missing?
A benchmark appears only when the selected code and cohort meet the publication rules, including at least 10 entities after trimming. Report-wide coverage can be broader than an individual comparison.
Will the reporting period change?
Yes. The period displayed with the benchmark follows the processed source data when the publication snapshot is refreshed.