Gastroenterology reimbursement
by service line
Compare commercial rates for endoscopy, colonoscopy, office visits, pathology, and infused drugs without mixing professional fees, facility payments, or incompatible billing units.
Compare national gastroenterology rates by payer
Start with three common endoscopy services, then compare payer ranges and named billing entities in the state relevant to your question.
Aetna state variation for 45378
National 45378 rate distribution
Each marker shows the national average published rate across billing entities for that payer.
National 45378 rates by payer
| Payer | Rate period | Provider entities | P25 | Median | P75 | P90 | Average |
|---|---|---|---|---|---|---|---|
| Aetna | Q2 2026 | 19,212 | $485.78 | ||||
| Cigna | Q2 2026 | 578 | $828.77 | ||||
| United | Q2 2026 | 26,121 | $682.53 |
- Source
- Negotiated rates published directly by payers in their machine-readable files.
- Rate shown
- Published commercial rate for diagnostic colonoscopy (45378).
- 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 gastroenterology providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
Gastroenterology provider rates by payer
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|
Named provider examples are available in a scoped gastroenterology market comparison.
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.How reimbursement changes across gastroenterology services
Keep procedures, visits, pathology, laboratory services, and drugs in their own payment units so payer rates stay comparable.
| Service line / billing code | Nat'l avg | Aetna | Cigna | United | Anthem |
|---|---|---|---|---|---|
$ per service · 1 code | |||||
43239Upper GI endoscopy with biopsy | $455.73 | — | |||
$ per service · 3 codes | |||||
45378Diagnostic colonoscopy | $485.78 | — | |||
45380Colonoscopy with biopsy | $577.56 | — | |||
45385Colonoscopy with lesion removal by snare | $649.19 | — | |||
$ per visit · 8 codes | |||||
99203New patient office visit, level 3 | $131.48 | — | |||
99204New patient office visit, level 4 | $203.41 | — | |||
99213Established patient office visit, level 3 | $95.80 | — | |||
99214Established patient office visit, level 4 | $139.60 | — | |||
99215Established patient office visit, level 5 | $197.45 | — | |||
99223Initial hospital care, high level | $237.69 | — | |||
99232Subsequent hospital care, moderate level | $98.83 | — | |||
99233Subsequent hospital care, high level | $138.73 | — | |||
$ per service · 6 codes | |||||
36415Collection of venous blood by venipuncture | $7.66 | — | |||
80053Comprehensive metabolic panel | $16.18 | — | |||
83036Hemoglobin A1c | $14.80 | — | |||
85025Complete blood count with differential | $12.05 | — | |||
88305Surgical pathology, gross and microscopic examination | $108.22 | ||||
88313Special stains, group 2 | $111.63 | ||||
$ per HCPCS unit · 2 codes | |||||
J1745Infliximab | $50.90 | — | |||
J3380Vedolizumab | $28.41 | — | |||
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 these gastroenterology rates are calculated
We start with negotiated rates published in payer machine-readable files and included in the underlying professional gastroenterology report. For each selected billing code, eligible records are grouped by payer and summarized as averages and percentile distributions.
- Rate sourceThe displayed amount is a negotiated rate published in a payer machine-readable file, not a paid claim, billed charge, or utilization-based estimate.
- CalculationNational values summarize eligible published records across available states. State views use records associated with the selected state. Averages are not weighted by procedure volume.
- Provider entityNamed examples use payer-file NPI and TIN records. An entity may be a clinician, group, health system, or other billing organization; the listed state may not be its headquarters.
- Comparable ratesMatch the exact procedure, billing component, modifier, site of service, payment unit, payer product, and network. Facility, anesthesia, pathology, drug, and administration payments may be separate.
Get the gastroenterology reimbursement data you're looking for
Choose the services, payers, states, networks, and provider entities relevant to your question. We'll confirm the available coverage and prepare the comparison.
- Tell us your marketShare the specialty, geography, payers, networks, and providers.
- We find comparable ratesPayerPrice aligns billing codes, services, settings, and units.
- Get your market viewSee relevant payer and provider rates organized around your question.
We'll tell you what the data can support, where the gaps are, and the clearest way to structure the comparison.
Trusted by teams that need defensible reimbursement data
How to interpret gastroenterology rates
How to interpret the selected market and payer-published rates.
Should ASC and hospital outpatient gastroenterology rates be compared?
Only when the billing component is the same. This page is configured for professional gastroenterology rates; ASC and hospital outpatient facility payments should be evaluated separately.
How should diagnostic, biopsy, and lesion-removal colonoscopy rates be benchmarked?
Compare each procedure using its exact billing code. Diagnostic colonoscopy, biopsy, and lesion removal represent different services and should not be combined into one rate.
Are pathology, anesthesia, drug, and administration payments included?
Not in the selected endoscopy rate. These services may appear as separate billing codes and should be evaluated independently when they are relevant to the comparison.
Which billing details can change the comparison?
Confirm the billing code, modifier, site of service, professional or facility context, payment unit, payer product, and network before treating two rates as comparable.
How are named provider examples selected?
The public table selects up to six billing entities distributed across the payer's published rate range. Rates at or below the payer median are shown publicly; higher-rate examples are available in the state preview.