Colonoscopy With Biopsy Cost in California
Colonoscopy and biopsy
$1,400Hospital 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
California Medicare physician rate (2026)
+12.9% vs nationalAverage of 29 localities. Office range $509.04–$640.93.
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 $566 on the Medicare allowed amount for colonoscopy with biopsy. 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.
Your ZIP in California
A ZIP-level lookup matters more in California than in any other state; compare your area, whether that is the Bay Area, Los Angeles, San Diego, Sacramento, the Central Valley, or the rural north.
What colonoscopy with biopsy costs at hospitals near you
Everything above is a national average. The hospital you pick in California 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. In California the office and hospital physician lines for this CPT differ by $357.68.
National vs California
Where California ranks for this CPT
CPT 45380 by California locality
| Locality | Office |
|---|---|
| san jose-sunnyvale-santa clara (san benito cnty) | $640.93 |
| san jose-sunnyvale-santa clara (santa clara cnty) | $638.98 |
| san francisco-oakland-berkeley (marin cnty) | $626.91 |
| san francisco-oakland-berkeley (san francisco/san mateo/alameda/contra costa cnty) | $626.43 |
| napa | $591.68 |
| vallejo | $591.00 |
| santa rosa-petaluma | $556.75 |
| santa cruz-watsonville | $551.15 |
| san diego-chula vista-carlsbad | $545.63 |
| los angeles-long beach-anaheim (los angeles/orange cnty) | $544.07 |
| oxnard-thousand oaks-ventura | $541.64 |
| santa maria-santa barbara | $534.81 |
| sacramento-roseville-folsom | $534.69 |
| salinas | $532.71 |
| san luis obispo-paso robles | $524.09 |
| riverside-san bernardino-ontario | $513.60 |
| bakersfield | $510.29 |
| el centro | $509.11 |
| chico | $509.04 |
| fresno | $509.04 |
| hanford-corcoran | $509.04 |
| madera | $509.04 |
| merced | $509.04 |
| modesto | $509.04 |
| redding | $509.04 |
| stockton | $509.04 |
| visalia | $509.04 |
| yuba city | $509.04 |
| rest of california | $509.04 |
PE GPCI ranges from 1.096 to 1.442 in California. That index is why the same CPT is not one price statewide.
Colonoscopy With Biopsy and how California is priced
California is the most finely divided state in the Medicare fee schedule, with roughly thirty payment localities drawn around metropolitan statistical areas after CMS reformed the state's locality map. The San Francisco Bay Area carries some of the highest geographic adjustments in the nation, with San Francisco, San Jose, and the East Bay each priced separately, while Los Angeles, Orange County, San Diego, and Sacramento have their own localities at somewhat lower levels. Rural and inland counties fall into lower-cost localities, so the same procedure can carry meaningfully different Medicare-approved amounts within a single day's drive. No other state shows this much in-state variation on the fee schedule itself.
California's markets differ sharply: the Bay Area combines high wages with heavily consolidated hospital systems, Los Angeles offers enormous choice across a sprawling region, and the Central Valley and far north face genuine access shortages. Where you are treated within the state matters more here than almost anywhere else in the country. Academic medical centers in the Bay Area, Los Angeles, San Diego, and Sacramento handle much of the complex referral care.
This procedure: This is a colonoscopy during which the physician passes small forceps through the scope to take one or more tissue samples, called cold biopsies, from the colon lining. It is used when the doctor sees inflammation, an unusual patch, or needs to test for conditions like microscopic colitis, which can only be diagnosed under a microscope. From the patient's perspective it is identical to any colonoscopy: prep the day before, IV sedation, a 20 to 45 minute exam, and home the same day.
What Is Colonoscopy With Biopsy?
This is a colonoscopy during which the physician passes small forceps through the scope to take one or more tissue samples, called cold biopsies, from the colon lining. It is used when the doctor sees inflammation, an unusual patch, or needs to test for conditions like microscopic colitis, which can only be diagnosed under a microscope. From the patient's perspective it is identical to any colonoscopy: prep the day before, IV sedation, a 20 to 45 minute exam, and home the same day.
What Affects the Cost
- –Every biopsy container sent to the lab is billed separately by pathology, and workups for conditions like microscopic colitis involve samples from multiple colon segments.
- –The physician fee for 45380 is higher than the diagnostic-only code 45378 because sampling was performed.
- –Facility choice between hospital outpatient and freestanding endoscopy center remains the largest single price driver.
- –Separate anesthesia billing applies when a dedicated provider administers sedation.
- –If a polyp is also removed by snare during the same exam, an additional code (45385) is billed alongside this one.
Questions to Ask Before Booking
- 1.Was my colonoscopy ordered as a screening or for symptoms, and how will biopsies affect what I owe under my specific plan?
- 2.How many specimen jars might be sent to pathology and what is the charge per jar?
- 3.Is the pathology lab in my insurance network?
- 4.If you also remove a polyp with a snare, will both procedure codes be billed and what does that total?
- 5.For Medicare patients: what coinsurance applies this year when a screening turns into a biopsy?
Other featured procedures in California
Colonoscopy With Biopsy in other states
Colonoscopy With Biopsy in California: questions
The 2026 Medicare physician office rate for CPT 45380 averages $541.86 across 29 California localities, from $509.04 in CHICO to $640.93 in SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY). The hospital physician rate averages $184.18. Enter a ZIP for the exact locality.
Yes. CMS splits California into 29 payment localities. For this CPT the office physician fee spans $131.89 from the lowest to highest locality. A ZIP-level lookup matters more in California than in any other state; compare your area, whether that is the Bay Area, Los Angeles, San Diego, Sacramento, the Central Valley, or the rural north.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $108 for the office physician line or $37 for the hospital physician line in California. Medigap may cover that 20%. This is not the hospital facility fee.
No. $541.86 is only the physician's share. Adding Medicare's facility payment brings the total to about $1,400 in a hospital outpatient department, or about $834 at an ambulatory surgery centre. Anesthesia, pathology and other codes billed the same day are extra. California ranks #49 of 51 states on the physician line (13% above the national office rate of $479.97).