A colonoscopy is an examination of the large intestine with a flexible camera passed through the rectum. The diagnostic version, CPT 45378, is the base procedure: the doctor looks, and if nothing needs to be removed or sampled, this is the code the hospital bills. Most people are sedated and go home the same day.
What the price covers
The hospital's price for 45378 is the facility fee: the endoscopy suite, nursing, the scope and its cleaning, recovery time and disposable supplies. It usually does not include the gastroenterologist's professional fee, the anesthesia provider, or pathology if a sample is taken. Those are billed separately, often by different companies, and can add several hundred dollars to what you see here.
If polyps are found and removed, the code changes to 45385 (polyp removal) or 45380 (biopsy), and the price changes with it. A hospital's cash price for 45378 is the best starting point, not a guarantee of the final bill.
Screening versus diagnostic
A screening colonoscopy for someone with no symptoms is preventive care, which most insurance plans cover without cost-sharing. A diagnostic colonoscopy, done because of symptoms or a positive stool test, is not. The same procedure, the same room, a different code and a different bill. If you are insured, ask before the appointment which one will be billed.
Why prices vary so much
The spread between hospitals is often five to ten times for this code. Academic medical centers and large systems tend to list higher gross charges and higher negotiated rates; community hospitals and hospital-owned outpatient centers tend to be cheaper. Location matters less than ownership and system size. Freestanding ambulatory surgery centers, which are not in these files, are often cheaper still.
Questions to ask before you book
- Is this the self-pay price for CPT 45378, in writing?
- Does it include the physician, anesthesia and pathology, or are those separate?
- If a polyp is removed, what does the price become?
- Is there a prompt-pay or financial-assistance discount on top of the cash price?