Colonoscopy With Biopsy Cost in Missouri
Colonoscopy and biopsy
Missouri Medicare physician rate (2026)
-6.1% vs nationalAverage of 3 localities. Office range $431.30–$463.20.
Your ZIP in Missouri
Enter a ZIP code to see which Missouri locality covers you: metro St. Louis, metro Kansas City, or rest-of-state areas like Springfield, Columbia, Joplin, and the Bootheel.
What this number is
The figures on this page are 2026 Medicare physician allowed amounts for a specific CPT code: the professional fee, adjusted by geographic practice-cost indices. They are not a hospital chargemaster price, not your insurer's contracted rate, and not a quote. Hospital facility fees, anesthesia, implants, imaging reads, and pathology are billed separately when they apply. In Missouri the office and hospital physician lines for this CPT differ by $277.39.
National vs Missouri
Where Missouri ranks for this CPT
CPT 45380 by Missouri locality
| Locality | Office |
|---|---|
| metropolitan st. louis | $463.20 |
| metropolitan kansas city | $458.30 |
| rest of missouri | $431.30 |
PE GPCI ranges from 0.862 to 0.952 in Missouri. That index is why the same CPT is not one price statewide.
Colonoscopy With Biopsy and how Missouri is priced
Missouri is a three-locality state: metropolitan St. Louis and metropolitan Kansas City are each priced separately, and everywhere else falls into a rest-of-state locality with lower geographic adjustments. Both metro localities approve higher amounts than outstate Missouri, and the Kansas City locality applies only to the Missouri side of that metro, since the Kansas side prices under Kansas's statewide locality. Springfield, Columbia, and the rural counties all share rest-of-state factors. The metro-versus-outstate gap is the main pricing story here.
St. Louis and Kansas City hold the state's academic medical centers and most of its specialty depth, drawing patients from far beyond Missouri's borders, including southern Illinois and eastern Kansas. Outstate Missouri is served by regional hubs in Springfield, Columbia, and Cape Girardeau, with the Ozarks and Bootheel among the harder places to reach specialty care. Rural hospital viability has been a persistent concern across the state.
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 Missouri
Colonoscopy With Biopsy in other states
Colonoscopy With Biopsy in Missouri: questions
How much does colonoscopy with biopsy cost in Missouri?
The 2026 Medicare physician office rate for CPT 45380 averages $450.93 across 3 Missouri localities, from $431.30 in REST OF MISSOURI to $463.20 in METROPOLITAN ST. LOUIS. The hospital physician rate averages $173.54. Enter a ZIP for the exact locality.
Does the rate change inside Missouri?
Yes. CMS splits Missouri into 3 payment localities. For this CPT the office physician fee spans $31.90 from the lowest to highest locality. Enter a ZIP code to see which Missouri locality covers you: metro St. Louis, metro Kansas City, or rest-of-state areas like Springfield, Columbia, Joplin, and the Bootheel.
What will a Medicare patient owe for the physician fee?
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $90 for the office physician line or $35 for the hospital physician line in Missouri. Medigap may cover that 20%. This is not the hospital facility fee.
Is this the full colonoscopy with biopsy bill in Missouri?
No. $450.93 is the Medicare physician allowed amount for CPT 45380. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Missouri ranks #15 of 51 states on this physician line (6% below the national office rate of $479.97).