CPT 45378
Diagnostic colonoscopy
- Aetna
- $500.70
- Cigna
- $499.90
- United
- $695.10
- Anthem
- $434.39
Gastroenterology reimbursement rates in Georgia
Explore gastroenterology reimbursement rates in Georgia. Public state reference averages appear below. Detailed payer comparisons are available with a state preview.
1,933,766 national provider-rate observations4 payers in national source data50 states in national dataset20 billing codes in national dataset
Rate data shownJun–Jul 2026About these rates
Gastroenterology rate explorerThree reference services
Rate measure$ per service
Billing contextProfessional gastroenterology
Georgia gastroenterology reference averages
Publication period: Jun–Jul 2026CPT 45385
Colonoscopy with lesion removal by snare
- Aetna
- $679.61
- Cigna
- $682.86
- United
- $935.51
- Anthem
- $599.38
CPT 43239
Upper GI endoscopy with biopsy
- Aetna
- $477.07
- Cigna
- $465.80
- United
- $754.10
- Anthem
- $577.22
National gastroenterology rates by payer
Start with three common endoscopy services, then compare payer ranges and named billing entities in the state relevant to your question.
Aetna state variation for 45378
LowerHigher
Georgia
Select a state to reveal payer percentiles and provider examples.National 45378 rate distribution
PayerMedian
Published rate$ per service
$300$400$500$600$700
AetnaJun–Jul 2026
AetnaProviders24,815Average$440.29
$380.90median
CignaJun–Jul 2026
CignaProviders25,404Average$514.96
$436.34median
UnitedJun–Jul 2026
UnitedProviders26,121Average$682.53
$611.92median
AnthemJun–Jul 2026
AnthemProviders22,825Average$619.44
$460.85median
Each marker shows the national median published rate across billing entities for that payer.
National 45378 rates by payer
| Payer | Rate period | Provider entities | P25 | Median | P75 | P90 | Average |
|---|---|---|---|---|---|---|---|
| Aetna | Jun–Jul 2026 | 24,815 | $380.90 | $440.29 | |||
| Cigna | Jun–Jul 2026 | 25,404 | $436.34 | $514.96 | |||
| United | Jun–Jul 2026 | 26,121 | $611.92 | $682.53 | |||
| Anthem | Jun–Jul 2026 | 22,825 | $460.85 | $619.44 |
About these rates
About this rate table
- Source
- Negotiated or fee-schedule amounts 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.
National: Gastroenterology provider rates by payer (CPT 45378)
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|---|---|---|---|---|
| IRONWOOD GASTROENTEROLOGY PLLCNPI 1003031931 · Tax ID 208692925 | AZ | 3 | $239.35 | -$141.55 | Below P25 |
| HORIZONS DIAGNOSTICS LLCNPI 1437150455 · Tax ID 582470331 | GA | 29 | $273.73 | -$107.17 | Below P25 |
| MUKUL KHANDELWAL PANPI 1316928849 · Tax ID 522109222 | MD | 20 | $302.26 | -$78.64 | Below P25 |
| MEMORIAL HOSPITALNPI 1073613808 · Tax ID 381358208 | MI | 503 | $329.07 | -$51.83 | P25 to median |
| MERCY CLINIC FORT SMITH COMMUNITIESNPI 1013170596 · Tax ID 261318597 | AR | 953 | Median to P75 | ||
| MEMORIAL CLINICAL NUTRITION GROUPNPI 1821152943 · Tax ID 133278576 | PA | 10 | Above P75 |
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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 | Aetna | Cigna | United | Anthem |
|---|---|---|---|---|
$ per service · 1 code | ||||
43239Upper GI endoscopy with biopsy | $414.70 | $489.05 | $736.27 | $655.76 |
$ per service · 3 codes | ||||
45378Diagnostic colonoscopy | $440.29 | $514.96 | $682.53 | $619.44 |
45380Colonoscopy with biopsy | $525.94 | $625.50 | $864.63 | $719.01 |
45385Colonoscopy with lesion removal by snare | $589.83 | $701.56 | $917.03 | $832.98 |
$ per visit · 8 codes | ||||
99203New patient office visit, level 3 | $119.65 | $154.18 | $177.47 | $174.32 |
99204New patient office visit, level 4 | $185.02 | $238.76 | $268.94 | $267.70 |
99213Established patient office visit, level 3 | $87.50 | $112.93 | $125.78 | $124.48 |
99214Established patient office visit, level 4 | $127.70 | $163.95 | $181.93 | $177.22 |
99215Established patient office visit, level 5 | $179.29 | $233.90 | $247.43 | $252.70 |
99223Initial hospital care, high level | $218.82 | $298.23 | $318.54 | $335.63 |
99232Subsequent hospital care, moderate level | $90.98 | $117.65 | $119.74 | $128.64 |
99233Subsequent hospital care, high level | $126.08 | $171.94 | $173.99 | $186.41 |
$ per service · 6 codes | ||||
36415Collection of venous blood by venipuncture | $6.68 | $6.31 | $3.64 | $6.34 |
80053Comprehensive metabolic panel | $13.62 | $24.45 | $9.33 | $17.84 |
83036Hemoglobin A1c | $12.68 | $22.29 | $8.66 | $17.19 |
85025Complete blood count with differential | $10.16 | $18.38 | $6.94 | $13.50 |
88305Surgical pathology, gross and microscopic examination | $94.26 | $86.49 | $87.58 | $154.13 |
88313Special stains, group 2 | $94.82 | $85.10 | $88.20 | $132.59 |
$ per HCPCS unit · 2 codes | ||||
J1745Infliximab | $44.02 | $35.24 | $39.51 | $49.87 |
J3380Vedolizumab | $26.04 | $22.33 | $24.97 | $31.05 |
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Book a 20-min scoping call No trial or data preparation required.How these gastroenterology rates are calculated
We start with negotiated or fee-schedule 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 or fee-schedule amount 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
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- We find comparable ratesPayerPrice aligns billing codes, services, settings, and units.
- Get your market viewSee relevant payer and provider rates organized around your question.
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Explore gastroenterology rates by state
Choose a state to compare payer reference averages for common services.
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.