How Much Does Diagnostic colonoscopy Cost?
Diagnostic colonoscopy (CPT 45378) costs $165 at Medicare rates. Hospital outpatient rate: $950.
Cost Comparison by Payer
How much Diagnostic colonoscopy costs across different settings and payers
How to Reduce Your Cost for Diagnostic colonoscopy
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
For this procedure, the office rate ($378) differs from the facility rate ($165). Ask if it can be done in an office setting.
- 3 Shop around — costs vary significantly
Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.
- 4 Check ambulatory surgery centers (ASCs)
This procedure is available at ASCs for $510, compared to $950 at hospital outpatient departments. ASCs often offer lower costs with comparable quality.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU (11.32) x CF ($33.40) = $378
Related Procedures
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Frequently Asked Questions
How much does Diagnostic colonoscopy cost?
The Medicare facility rate for Diagnostic colonoscopy is $165. In a hospital outpatient setting, the rate is $950. At an ambulatory surgery center, the rate is $510. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Diagnostic colonoscopy cost without insurance?
Without insurance, the cost of Diagnostic colonoscopy can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Diagnostic colonoscopy?
Most commercial health insurance plans and Medicare cover Diagnostic colonoscopy when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.