Colonoscopy With Biopsy Cost in Illinois
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
Illinois Medicare physician rate (2026)
+0.3% vs nationalAverage of 4 localities. Office range $457.42–$501.06.
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 Illinois
Enter a ZIP code to see which Illinois locality applies to you, whether Chicago proper, the suburban collar counties, the Metro East near St. Louis, or downstate cities like Springfield, Peoria, and Champaign.
What colonoscopy with biopsy costs at hospitals near you
Everything above is a national average. The hospital you pick in Illinois 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 Illinois the office and hospital physician lines for this CPT differ by $292.07.
National vs Illinois
Where Illinois ranks for this CPT
CPT 45380 by Illinois locality
| Locality | Office |
|---|---|
| suburban chicago | $501.06 |
| chicago | $500.70 |
| east st. louis | $466.19 |
| rest of illinois | $457.42 |
PE GPCI ranges from 0.913 to 1.027 in Illinois. That index is why the same CPT is not one price statewide.
Colonoscopy With Biopsy and how Illinois is priced
Illinois uses one of the more detailed locality maps in the Midwest: Chicago has its own locality, the suburban collar counties are priced separately, the East St. Louis area carries its own locality tied to the St. Louis market, and the rest of the state shares a fourth. Approved amounts step down noticeably from the city and suburbs to downstate, so the same procedure prices differently in Chicago, Naperville, Belleville, and Springfield. This four-way split makes Illinois one of the states where a ZIP-level check genuinely changes the answer. Downstate rates align more closely with neighboring rural states than with Chicagoland.
Chicago is one of the country's great medical hubs, with multiple academic medical centers and deep specialist supply, and its suburbs support large competing systems of their own. Downstate Illinois is a different market: smaller cities like Peoria, Springfield, and Champaign serve wide rural areas, and the Metro East suburbs orient toward St. Louis providers. Where you sit on that map shapes both price and choice.
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 Illinois
Colonoscopy With Biopsy in other states
Colonoscopy With Biopsy in Illinois: questions
The 2026 Medicare physician office rate for CPT 45380 averages $481.34 across 4 Illinois localities, from $457.42 in REST OF ILLINOIS to $501.06 in SUBURBAN CHICAGO. The hospital physician rate averages $189.27. Enter a ZIP for the exact locality.
Yes. CMS splits Illinois into 4 payment localities. For this CPT the office physician fee spans $43.64 from the lowest to highest locality. Enter a ZIP code to see which Illinois locality applies to you, whether Chicago proper, the suburban collar counties, the Metro East near St. Louis, or downstate cities like Springfield, Peoria, and Champaign.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $96 for the office physician line or $38 for the hospital physician line in Illinois. Medigap may cover that 20%. This is not the hospital facility fee.
No. $481.34 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. Illinois ranks #36 of 51 states on the physician line (within 2% of the national office rate of $479.97).