Colonoscopy (Diagnostic) Cost
Diagnostic colonoscopy
$1,115Hospital outpatient total2026 Medicare, physician + facility- ✓Your ZIP's wage-adjusted hospital and surgery centre rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
National Medicare physician rate (2026)
What the whole procedure costs
The rate above is the physician’s fee on its own. The facility bills separately, and for most procedures the facility is the larger half of the bill. These are 2026 national Medicare amounts.
Choosing a surgery centre over a hospital saves about $440 on the Medicare allowed amount for colonoscopy (diagnostic). Ask whether your procedure can be done at an ambulatory surgery centre.
This is Medicare's separate payment to the facility on top of the physician's fee. Medicare allowed amounts are not what an uninsured patient is charged, and not a quote. Private plans typically allow more.
Get the rate for your ZIP
CMS adjusts this CPT by locality. A five-digit ZIP is enough — no account, no insurance card.
What colonoscopy (diagnostic) costs at hospitals near you
Everything above is a national average. The hospital you pick in your area moves the bill more than anything else you control.
Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery centre rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again. For this code the office and hospital physician lines differ by $213.43.
How CMS prices CPT 45378
Work is about 28% of the office total RVU; practice expense is about 68%. Localities with a high PE GPCI move this code more when practice expense is a large share.
Office vs hospital for this code
Office (non-facility) physician rate: $378.10. Hospital (facility) physician rate: $164.67.
Medicare patients typically owe 20% of the allowed amount after the Part B deductible — about $76 for the office physician fee, before any Medigap coverage. That coinsurance does not include a hospital facility fee.
Labeled private-plan and cash ranges on this page are arithmetic multiples of Medicare, not negotiated quotes. Ask the billing office for the CPT code, the site of service, and a good-faith estimate.
What Is Colonoscopy (Diagnostic)?
A diagnostic colonoscopy examines the entire large intestine with a flexible camera inserted through the rectum, looking for the cause of symptoms such as bleeding, chronic diarrhea, or abdominal pain, or following up an abnormal stool test. You complete a bowel-cleansing prep the day before, receive IV sedation, and the exam takes 20 to 45 minutes. This specific code means the doctor looked but did not remove or sample anything; you go home the same day with a driver.
What Affects the Cost
- –Facility setting is the dominant variable: hospital outpatient departments routinely charge several times what freestanding endoscopy centers do.
- –Anesthesia billed separately, particularly monitored propofol sedation, adds a meaningful independent charge.
- –If any polyp or tissue is encountered and removed, the procedure converts to a higher-paying code (45380 or 45385) plus pathology fees.
- –The bowel prep kit may be a pharmacy cost, with prescription-only preps costing more than over-the-counter regimens.
- –A pre-procedure consult with the gastroenterologist is often billed as its own office visit.
How It Is Billed
CPT 45378 is the base colonoscopy code used when nothing is biopsied or removed; the physician fee, facility fee, and anesthesia fee arrive as separate claims. The moment the doctor removes a polyp or takes a sample, this code is replaced by the appropriate intervention code with higher payment plus a lab claim, which is why written estimates for colonoscopy should always show both the no-findings and with-findings scenarios. How the procedure is coded, screening versus diagnostic, is decided by the reason it was ordered, not by what was found.
Insurance & Coverage Notes
Because this code is by definition diagnostic, meaning you had symptoms or a positive stool test, standard deductible and coinsurance apply; it is not billed under the free preventive screening benefit. One important protection: under federal rules, a colonoscopy performed to follow up a positive non-invasive screening test, such as Cologuard or FIT, must be treated as part of screening by most commercial plans and by Medicare, so cost sharing should be waived; make sure it is coded that way. If you have symptoms, however, diagnostic cost sharing is unavoidable.
Questions to Ask Before Booking
- 1.Is my procedure being ordered as diagnostic or screening, and what exactly will I owe under each?
- 2.If this follows a positive Cologuard or FIT test, will it be billed with the screening modifier so my cost sharing is waived?
- 3.What are the facility fees at the hospital versus the endoscopy center you use?
- 4.Who provides sedation and are they in network?
- 5.If you find and remove a polyp, what does my estimate become?
Colonoscopy (Diagnostic) (CPT 45378): questions
The 2026 national Medicare physician rate for CPT 45378 is $378.10 in an office and $164.67 in a hospital. Enter a ZIP code to apply the geographic adjustment for your locality.
Medicare uses a different practice-expense RVU in a facility. For CPT 45378 that produces an office rate of $378.10 and a hospital physician rate of $164.67 (a $213.43 gap). The hospital’s own facility charge is extra and often larger than this entire physician line.
A diagnostic colonoscopy examines the entire large intestine with a flexible camera inserted through the rectum, looking for the cause of symptoms such as bleeding, chronic diarrhea, or abdominal pain, or following up an abnormal stool test. You complete a bowel-cleansing prep the day before, receive IV sedation, and the exam takes 20 to 45 minutes. This specific code means the doctor looked but did not remove or sample anything; you go home the same day with a driver. CMS bills it as “Diagnostic colonoscopy.”
Not on its own. $378.10 is the physician allowed amount. Medicare also pays the facility, which takes the total to about $1,115 in a hospital outpatient department or about $675 at an ambulatory surgery centre. Anesthesia, pathology and imaging interpretation billed under other codes are separate again. Private-plan allowed amounts are often higher than Medicare; your deductible and coinsurance still apply.
For cash-pay surgery shopping, use this CPT as the Medicare floor when you compare written quotes. How cash-price shopping works.