Colonoscopy With Polyp Removal Cost in Illinois
Colonoscopy w/lesion removal
$1,446Hospital 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)
+1.0% vs nationalAverage of 4 localities. Office range $480.54–$524.78.
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 polyp removal. 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 polyp removal 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.
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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 $267.23.
National vs Illinois
Where Illinois ranks for this CPT
CPT 45385 by Illinois locality
| Locality | Office |
|---|---|
| chicago | $524.78 |
| suburban chicago | $523.22 |
| east st. louis | $490.56 |
| rest of illinois | $480.54 |
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 Polyp Removal 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 colonoscopy code means the physician found one or more polyps and removed them using a snare, a thin wire loop that lassoes the polyp and cuts it free, often with cauterizing current. Snare removal is the standard technique for larger polyps and is the step that gives colonoscopy its cancer-preventing power, since removing precancerous polyps stops them from progressing. The patient experience is unchanged from any colonoscopy: prep, IV sedation, a 20 to 45 minute procedure, and same-day discharge.
What Is Colonoscopy With Polyp Removal?
This colonoscopy code means the physician found one or more polyps and removed them using a snare, a thin wire loop that lassoes the polyp and cuts it free, often with cauterizing current. Snare removal is the standard technique for larger polyps and is the step that gives colonoscopy its cancer-preventing power, since removing precancerous polyps stops them from progressing. The patient experience is unchanged from any colonoscopy: prep, IV sedation, a 20 to 45 minute procedure, and same-day discharge.
What Affects the Cost
- –Every removed polyp goes to pathology in its own container, and each container is a separate lab charge.
- –The physician fee for snare polypectomy is the highest of the common colonoscopy codes, above both biopsy (45380) and diagnostic (45378).
- –Facility setting remains the biggest overall cost lever, with hospitals charging far more than endoscopy centers.
- –Separately billed anesthesia adds its own professional fee.
- –Large or complex polyps may require advanced removal techniques or clips to close the site, which can add device and procedure charges.
- –Finding polyps shortens your recommended interval to the next colonoscopy, pulling that future cost closer.
Questions to Ask Before Booking
- 1.If polyps are removed during my screening, will the procedure still be billed with the preventive modifier at no cost share to me?
- 2.What will the pathology lab charge per polyp, and is that lab in network?
- 3.For Medicare: what percentage coinsurance applies to polyp removal during a screening this year?
- 4.If you find a large polyp needing a special technique or clips, how does the cost change?
- 5.How soon will I need my next colonoscopy if polyps are found, and will that one count as screening or surveillance for coverage?
Other featured procedures in Illinois
Colonoscopy With Polyp Removal in other states
Colonoscopy With Polyp Removal in Illinois: questions
The 2026 Medicare physician office rate for CPT 45385 averages $504.78 across 4 Illinois localities, from $480.54 in REST OF ILLINOIS to $524.78 in CHICAGO. The hospital physician rate averages $237.55. Enter a ZIP for the exact locality.
Yes. CMS splits Illinois into 4 payment localities. For this CPT the office physician fee spans $44.24 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 $101 for the office physician line or $48 for the hospital physician line in Illinois. Medigap may cover that 20%. This is not the hospital facility fee.
No. $504.78 is only the physician's share. Adding Medicare's facility payment brings the total to about $1,446 in a hospital outpatient department, or about $880 at an ambulatory surgery centre. Anesthesia, pathology and other codes billed the same day are extra. Illinois ranks #37 of 51 states on the physician line (within 2% of the national office rate of $500.01).