Colonoscopy Cost in Wyoming (2026): Average Prices & What You'll Pay
What does a colonoscopy cost in Wyoming?
For a commercially insured patient, a colonoscopy in Wyoming typically runs $1,037–$2,912 once facility and physician fees are combined. The median reported facility price across 17 hospitals is $918. The figures draw on CMS fee schedules and hospital price transparency data published under federal law.
Wyoming Medicine (based in Casper) and Banner Health serve much of the state's population, but Wyoming's frontier geography means the nearest hospital is often 50–100 miles away. Many Wyoming residents cross into Colorado or Utah for non-emergency specialty care. Critical access hospitals are widespread, and prices at rural Wyoming facilities often run high relative to the care complexity they handle.
Colonoscopy pricing is particularly sensitive to screening vs. diagnostic coding. A screening colonoscopy is typically covered at 100% under preventive care benefits, but if a polyp is removed or a finding is documented during the same visit, the claim is often re-coded as diagnostic — triggering your deductible and coinsurance. Ambulatory surgery centers perform over 70% of colonoscopies nationally and charge substantially less than hospital outpatient settings.
Location within the state matters too: Gillette has the lowest metro median ($820) while Rock Spring runs highest ($2,373) — a 2.9× difference inside Wyoming alone. The same colonoscopy that costs $102 at Johnson County Memorial Hospital in Buffalo reaches $8,469 at Memorial Hospital of Converse County in Douglas — a 83× gap across the 17 Wyoming hospitals reporting prices. A typical Wyoming facility lands around $918 — most sit in the $475–$1,556 band. Self-pay patients are quoted more than insurers actually pay: the median cash price is $918 versus a median negotiated rate of $362 — about 2.5× higher, so asking for the cash or insurer-negotiated rate is often the single biggest lever on your bill.
Colonoscopy billing is more complex than most procedures — and most patients find out after the fact.
The free toolkit shows you:
- ✓ Which 3–4 separate bills typically arrive (and which to dispute)
- ✓ Why anesthesia is often billed out-of-network even at in-network facilities
- ✓ The exact questions to ask before you schedule — that can cut your bill 30–50%
- ✓ What insurance actually covers vs. what they hope you won't notice
- ✓ A real patient billing breakdown, line by line
Free for patients — takes 30 seconds to get.
We'll email it to you immediately. No account required, no spam.
Forecast your out-of-pocket cost
- Lower-cost hospitals (bottom 25%): under $475
- Median hospital: $918
- Higher-cost hospitals (top 30%): $1,556+
That's a 3× spread for the same procedure — driven entirely by which facility you choose, not by clinical complexity.
- Patient A (higher-rate plan or out-of-network): ~$1,556
- Patient B (lower-rate in-network plan): ~$529
Where colonoscopy costs vary in Wyoming
Pins show hospitals with price-transparency data (colored by vs. state average) and nearby ambulatory surgery centers, imaging centers, and other facilities (colored by type). Click any pin for facility name and estimated cost range.
See every Wyoming hospital's price
The 5 cheapest are shown. Enter your email to reveal the rest of the map and unlock all 12 remaining facilities — instantly.
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Estimate YOUR exact out-of-pocket cost →
Cheapest Colonoscopy Providers in Wyoming
Based on declared cash/self-pay prices from CMS hospital price transparency files.
| # | Facility | City | Price | vs Median |
|---|---|---|---|---|
| 1 | Crook County Hospital | Sundance, WY | $262 | -$656 |
| 2 | Sublette County Health | WY | $390 | -$528 |
| 3 | POWELL VALLEY HEALTHCARE INC | WY | $425 | -$493 |
| 4 | Memorial Hospital of Carbon County | Rawlins, WY | $492 | -$426 |
| 5 | St Johns Health | WY | $533 | -$385 |
| 6 | Sagewest Health Care | Riverton, WY | $642 | -$276 |
| 7 | Campbell County Memorial Hospital | Gillette, WY | $820 | -$98 |
| 8 | South Lincoln Medical Center | WY | $907 | -$11 |
Prices are declared self-pay rates. Contact each facility for a formal quote before scheduling.
The facility you choose matters more than almost anything else — the same procedure, same quality, same state can cost 5× more at one hospital versus the one down the road.
→ Compare all procedure costs → Colonoscopy costs nationwide
Check YOUR hospital's pricing → Estimate YOUR exact cost →
What you'll actually pay — example scenarios
| Your situation | Estimated out-of-pocket |
|---|---|
| Deductible not yet met (pay in full) | ~$1,766 |
| Deductible met — 20% coinsurance | ~$353 |
| Out-of-network provider | $3,885+ |
Based on a typical episode cost of $1,766 (facility + physician fees). Your actual cost depends on your plan deductible, coinsurance rate, and network tier. Get YOUR personalized estimate →
What this means for you
If you haven't met your deductible, you are effectively a cash-pay patient.
That means:
- You should verify your hospital is in-network before an elective visit when possible
- The cheapest facility can save you $98+ vs. the median.
This is the single biggest lever most patients have to reduce their cost.
Lower-cost options in Wyoming start around $475 or below. Most hospitals cluster between $475 and $1,947. A smaller group reports prices above that — often academic medical centers or high-cost markets.
If you're comparing specific hospitals, the lowest self-pay rates reported in this dataset include: Johnson County Memorial Hospital in Buffalo (cash price from $212); Memorial Hospital of Converse County in Douglas (cash price from $226); Crook County Hospital in Sundance (cash price from $262). These are declared cash prices — contact each facility for a formal quote before scheduling.
How where you go changes what you pay for colonoscopy
The same colonoscopy bundles different services depending on the setting — facility fee, surgeon fee, and anesthesia each arrive as separate bills. Estimated ranges below reflect the typical full bundled cost, including all expected charges.
- Facility fee $201–$3,794
- Professional fee $84–$8,276
Estimated from CMS fee schedules + commercial rate multipliers
- Facility fee $201–$8,469
- Professional fee $84–$8,276
Estimated from CMS fee schedules + commercial rate multipliers
- Facility fee $222–$1,642
- Professional fee $84–$8,276
- Anesthesia $184–$492
Estimated from CMS fee schedules + commercial rate multipliers
Note: Ambulatory surgery centers (ASCs) are often 30–60% cheaper than hospital outpatient departments for the same procedure. Most ASC prices are not in the hospital transparency dataset above. Ask your doctor whether this procedure can be done at a freestanding ASC.
- Best value hospitals (lowest prices): Campbell County Memorial Hospital: $820; Johnson County Memorial Hospital: $212; Memorial Hospital of Converse County: $226
- Most expensive (outpatient): ASPEN MOUNTAIN MEDICAL: ~$2,373; North Big Horn Hospital: ~$1,527
→ Choosing the right facility can save $98+ vs. the state median.
Wyoming Colonoscopy prices by facility
All prices below come from hospital chargemasters — the official price lists each hospital must publish under federal law. Gross charge is the undiscounted list price; cash price is the self-pay rate; negotiated range covers the spread across insurance contracts.
- Cash price — the self-pay rate you can actually negotiate and pay
- Negotiated rate — if reported by the hospital across insurance contracts
- Gross charge — fallback only; this is the inflated list price few people pay
This reflects the real prices patients encounter — not inflated chargemaster rates.
| # | Facility | City | Your Price | vs Median | Gross Charge |
|---|---|---|---|---|---|
| #1 | Campbell County Memorial Hospital | Gillette, WY | $820 | -$98 | $820–$5,357 |
| #2 | Johnson County Memorial Hospital | Buffalo, WY | $212 | -$706 | $128–$2,594 |
| #3 | Memorial Hospital of Converse County | Douglas, WY | $226 | -$692 | $185–$6,891 |
| #4 | Crook County Hospital | Sundance, WY | $262 | -$656 | $262–$1,112 |
| #5 | Sublette County Health | WY | $390 | -$528 | $434–$435 |
| #6 | POWELL VALLEY HEALTHCARE INC | WY | $425 | -$493 | $500–$3,031 |
| #7 | Memorial Hospital of Carbon County | Rawlins, WY | $492 | -$426 | $657–$2,188 |
| #8 | St Johns Health | WY | $533 | -$385 | $533–$1,750 |
| #9 | Sagewest Health Care | Riverton, WY | $642 | -$276 | $1,070–$5,986 |
| #10 | South Lincoln Medical Center | WY | $907 | -$11 | $1,210 |
| #11 | Ivinson Memorial Hospital | Laramie, WY | $911 | -$7 | $911–$5,952 |
| #12 | SHERIDAN MEMORIAL HOSPITAL | WY | $924 | +$6 | $1,155–$1,546 |
| #13 | SUMMIT MEDICAL LLC | Casper, WY | $935 | +$17 | $2,281 |
| #14 | Star Valley Health | Afton, WY | $1,137 | +$219 | $1,625–$3,755 |
| #15 | West Park Hospital - Cody Regional | WY | $1,479 | +$561 | $1,741 |
| #16 | North Big Horn Hospital | WY | $1,527 | +$609 | $1,527–$4,039 |
| #17 | ASPEN MOUNTAIN MEDICAL | Rock Spring, WY | $2,373 | +$1,455 | $2,373 |
Unlock all 12 remaining Wyoming hospitals
Enter your email to reveal the full table instantly — and we'll email you the complete price list as a PDF to keep.
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Source: CMS hospital price transparency machine-readable files. vs Median = savings or premium relative to the state median price. Gross Charge = undiscounted list price for reference.
Received a bill? Check it for errors → Estimate YOUR cost before you go →
Compare other procedures in Wyoming:
Where you can save the most on colonoscopy in Wyoming
These facilities have the lowest declared prices relative to the state median — they represent the best opportunities to reduce your out-of-pocket cost for this procedure.
| Facility | City | Your Price | vs Median |
|---|---|---|---|
| Campbell County Memorial Hospital | Gillette, WY | $820 | -$98 |
| Johnson County Memorial Hospital | Buffalo, WY | $212 | -$706 |
| Memorial Hospital of Converse County | Douglas, WY | $226 | -$692 |
| Crook County Hospital | Sundance, WY | $262 | -$656 |
| Sublette County Health | WY | $390 | -$528 |
How to choose a lower-cost facility
- Choose independent outpatient centers when possible — freestanding ASCs (ambulatory surgical centers) consistently charge less than hospital outpatient departments for identical procedures.
- Ask for the cash price if your deductible isn't met — self-pay rates are often lower than what insurance pays before your deductible is satisfied, especially at facilities that have a high cash-price discount.
- Avoid hospital outpatient departments for routine cases — hospital-owned locations add a facility fee that freestanding centers don't charge, often adding $500–$1,500 to the same procedure.
Most expensive colonoscopy providers in Wyoming
These facilities report the highest prices for this procedure. Academic medical centers and specialty hospitals often top this list — their gross charges rarely reflect what anyone actually pays, but understanding the spread helps you negotiate.
| Facility | City | Price | vs Median |
|---|---|---|---|
| ASPEN MOUNTAIN MEDICAL | Rock Spring, WY | $2,373 | +$1,455 |
| North Big Horn Hospital | WY | $1,527 | +$609 |
| West Park Hospital - Cody Regional | WY | $1,479 | +$561 |
| Star Valley Health | Afton, WY | $1,137 | +$219 |
| SUMMIT MEDICAL LLC | Casper, WY | $935 | +$17 |
Why prices vary this much
A small number of hospitals (1) report very high prices above $4,155, which drives much of the overall price range. Excluding these, most facilities cluster in a significantly tighter band.
Setting drives much of the gap in Wyoming: the median outpatient price is $864 versus $1,813 inpatient — about 2.1× more, so where a procedure is performed often matters more than which hospital you choose. Of the Wyoming facilities reporting prices, 6 fall in a low-cost tier (up to $475) while 6 sit in a high-cost tier ($1,947 and up) — a lower-priced option almost always exists within the same state.
The spread comes from how each hospital sets its chargemaster (the undiscounted list price), what cash discounts it applies, and what rates it negotiates with each insurer. Facility classification matters too — a hospital-owned outpatient center adds a facility fee that a freestanding clinic does not. Understanding these mechanics is the first step to paying less.
Learn more:
→ Allowed amount vs negotiated rate — what your EOB is really saying
→ How to read your medical bill
→ Why hospital prices are so hard to find — and what to do about it
How insurance changes what you actually pay
Hospital list prices are only part of the picture. What you pay out of pocket depends on your deductible, your plan's out-of-pocket maximum, whether the facility is in-network, and whether your plan classifies the visit as outpatient or inpatient. A lower gross charge doesn't guarantee a lower bill if the facility is out-of-network or adds facility fees your plan doesn't cover.
Understand your cost before you go:
→ Deductible vs out-of-pocket max
→ EOB vs medical bill — complete guide
→ How to stop medical bill problems before they start (in-network vs out-of-network)
Compare colonoscopy costs in nearby states
Frequently asked questions: colonoscopy costs in Wyoming
How much does a colonoscopy cost in Wyoming?
Across 17 Wyoming hospitals that publish prices, a colonoscopy ranges from $102 to $8,469, with a median of $918. Most facilities fall between $475 and $1,556. What you pay depends on the facility, your insurance, and whether you have met your deductible.
Where is the cheapest place to get a colonoscopy in Wyoming?
Based on declared prices, the lowest-cost facility in our Wyoming data is Johnson County Memorial Hospital in Buffalo at about $212. By metro, Gillette has the lowest median ($820). Freestanding ambulatory surgery and imaging centers are often cheaper still and may not appear in hospital price data — ask your doctor whether one is an option.
Why is a colonoscopy so much cheaper at some Wyoming hospitals?
Prices vary up to 83× because each hospital sets its own list price, cash discount, and insurer-negotiated rates. In Wyoming, the median cash (self-pay) price is $918 versus a median negotiated rate of $362 — about 2.5× higher. Asking for the cash price or your insurer's negotiated rate is often the single biggest lever on what you pay.
How much will I actually pay out of pocket for a colonoscopy in Wyoming?
Your out-of-pocket cost depends on your deductible, coinsurance, out-of-pocket maximum, and whether the facility is in-network — not just the sticker price. If you have not met your deductible, you will typically pay the negotiated rate in full until you do. Use the CostKits cost forecaster to estimate your specific out-of-pocket amount before you go.
Explore all colonoscopy cost data
→ See colonoscopy costs across all states
Other Wyoming Hospitals and ambulatory surgery centers for Colonoscopy
These hospitals and ambulatory surgery centers are registered in the CMS National Provider Identifier (NPI) registry as active hospitals and ambulatory surgery centers in Wyoming. Cost estimates use the bundled service model for each place of service. Contact them directly for a formal quote.
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A FRANCINE TRYKA MD PC
3077336418 |
JACKSON, WY | Clinical Medical Laboratory | — | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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ADVANCED SURGICAL CARE OF WYOMING, LLC
3076603934 |
GILLETTE, WY | Ambulatory Surgical Center | $490–$10,410 bundled est. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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AFTER HOURS ECLINIC
9458990800 |
CHEYENNE, WY | Clinical Medical Laboratory | — | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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ALTITUDE ANALYSIS, INC
3073624552 |
ROCK SPRINGS, WY | Clinical Medical Laboratory | — | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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ANAPATH DIAGNOSTICS INC
3076349238 |
CHEYENNE, WY | Clinical Medical Laboratory | — | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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ANAPATH DIAGNOSTICS, INC
3076349238 |
CHEYENNE, WY | Clinical Medical Laboratory | — | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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BIG HORN BASIN PATHOLOGY
3075781850 |
CODY, WY | Clinical Medical Laboratory | — | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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CAMPBELL COUNTY HOSPITAL DISTRICT
3076887000 |
GILLETTE, WY | General Acute Care Hospital | $285–$12,070 bundled est. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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CAMPBELL COUNTY HOSPITAL DISTRICT
3076888602 |
GILLETTE, WY | Ambulatory Surgical Center | $490–$10,410 bundled est. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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CAMPBELL COUNTY HOSPITAL DISTRICT
3076888600 |
GILLETTE, WY | General Acute Care Hospital | $285–$12,070 bundled est. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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CASPER MEDICAL CENTER LLC
3079958100 |
CASPER, WY | General Acute Care Hospital | $285–$12,070 bundled est. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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CASPER MEDICAL CENTER LLC
3079958100 |
CODY, WY | General Acute Care Hospital | $285–$12,070 bundled est. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Est. cost = bundled estimate (facility fee + professional fee + anesthesia where applicable) based on CMS fee schedules and commercial rate multipliers. Contact each provider for an actual quote.
Source: CMS NPPES NPI Registry. NPI numbers can be verified at npiregistry.cms.hhs.gov.
Where You Get a Colonoscopy Matters
Hospital outpatient departments typically charge 2–4× more than ASCs or independent centers for the same procedure — same outcome, very different bill.
Hospital Outpatient Department
Hospital Outpatient Department typically carries a higher price for a colonoscopy. Facility fee billed separately from professional fee. Provider-based billing adds facility overhead. You can shop here — call ahead and ask for a self-pay or cash quote.
Ambulatory Surgery Center
Ambulatory Surgery Center typically carries a mid-range price for a colonoscopy. Typically 40–60% less than hospital OP for surgical procedures. Anesthesia billed separately. You can shop here — call ahead and ask for a self-pay or cash quote.
What's Actually on Your Colonoscopy Bill
A colonoscopy involves multiple providers — each bills separately. Understanding each line item helps you verify your Explanation of Benefits and catch billing errors.
Hospital Outpatient
- Facility Fee
- Gastroenterologist Fee
- Anesthesia — Anesthesiologist bills separately. Common source of surprise bills.
- Pathology (if biopsy) (conditional) — CPT 88305 for polyp specimen. Add only for 45380, 45381, 45385 — not for diagnostic 45378.
Asc
- ASC Facility Fee — Medicare ASC rate is ~$510 diagnostic, ~$657 therapeutic — approximately 46% less than OPPS at facility level.
- Gastroenterologist Fee
- Anesthesia
- Pathology (if biopsy) (conditional)
Colonoscopy Cost by Type
Which type your doctor orders changes the billing code — and what you pay. Here's how the common types differ.
Screening Colonoscopy
Billed as preventive care — often covered at $0 under the ACA when you are average-risk and in-network. Diagnostic only — no biopsy or polypectomy. ACA-covered at $0 for average-risk adults 45+.
Diagnostic Colonoscopy
Ordered to investigate symptoms or a prior finding — standard cost-sharing (deductible, coinsurance) applies. Same CPT as screening but billed as diagnostic — cost-sharing applies.
Colonoscopy with Biopsy
Adds a therapeutic step during the procedure, which changes the billing code and can add pathology charges.
Colonoscopy with Polypectomy
Adds a therapeutic step during the procedure, which changes the billing code and can add pathology charges.
Colonoscopy with Submucosal Injection
Adds a therapeutic step during the procedure, which changes the billing code and can add pathology charges.
Covered at $0 — But Only If It Stays a Screening
Under the ACA (§2713), preventive services — including colonoscopy for average-risk adults — must be covered at $0 with no cost-sharing when performed by an in-network provider.
The risk: Screening colonoscopy is covered at $0 under the ACA. If polyps are removed during the same procedure, it converts to a diagnostic colonoscopy and cost-sharing applies.
This Procedure Is Shoppable — Choosing the Right Facility Can Save Thousands
Colonoscopy is elective and schedulable. You have time to compare facilities — and hospital outpatient prices often run 2–4× higher than Hospital OP, ASC for identical clinical outcomes.
How to shop: Ask your doctor for the CPT code, then call 2–3 facilities and request an out-of-pocket cost estimate. Confirm your insurance is accepted. If uninsured, ask for the cash-pay rate — it's usually 20–50% below the list price.
Watch for Separate Bills from These Providers
A colonoscopy involves multiple providers: the facility, the operating physician, and often Anesthesia, Pathology (if biopsy). These providers bill independently — and each one may or may not be in your network, even if the facility is.
Action step: Before your procedure, ask the facility coordinator to confirm that all participating providers are in-network on your plan. The No Surprises Act (2022) protects you from unexpected out-of-network bills in many scenarios — but not all. Request a Good Faith Estimate (GFE) if you ask for one.
Who performs this: Colonoscopy is typically performed by a Gastroenterology or Colorectal Surgery. The specialist's professional fee is billed separately from the facility charge — you will likely receive separate bills from each.
CostKits compiles hospital price transparency data to help families make informed decisions. If you've received a bill for this procedure:
→ Analyze your medical bill for errors
→ How to negotiate your medical bills
→ Track and manage your healthcare costs (free account)
Colonoscopy billing is more complex than most procedures — and most patients find out after the fact.
The free toolkit shows you:
- ✓ Which 3–4 separate bills typically arrive (and which to dispute)
- ✓ Why anesthesia is often billed out-of-network even at in-network facilities
- ✓ The exact questions to ask before you schedule — that can cut your bill 30–50%
- ✓ What insurance actually covers vs. what they hope you won't notice
- ✓ A real patient billing breakdown, line by line
Free for patients — takes 30 seconds to get.
We'll email it to you immediately. No account required, no spam.
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About the Author
John Caruso, FSA, MAAA
Healthcare actuary with 20+ years of experience in insurance pricing, medical billing systems, and healthcare cost analytics.
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