Colonoscopy Cost by State: Prices in California, Texas, New York, Florida, and More
A colonoscopy in Manhattan costs more than three times the price of the same procedure in rural Ohio. That’s not a healthcare quality difference. That’s cost of living, insurer market concentration, and facility pricing power all rolling into one billing code.
Here’s what colonoscopy actually costs in eight major states — and why the gap is so wide.
Why State-Level Costs Vary So Much
Several structural factors create geographic price variation in colonoscopy costs:
Cost of living and labor costs: Facility overhead in New York City includes real estate, staffing wages, and utilities at Manhattan prices. An ASC in Columbus, Ohio faces a fraction of that overhead — and that’s reflected in lower facility fees.
Insurer market concentration: In states where one or two insurers control most of the commercial market (some southern and midwestern states), there’s less negotiating power on the provider side — fees are more constrained. In markets with fragmented insurer competition, individual providers and large health systems can negotiate higher rates.
Physician supply and GI specialist density: Markets with fewer gastroenterologists allow existing practices to charge more. Dense urban markets have more competition but also higher demand.
Facility type mix: States where ASCs handle a larger share of colonoscopies tend to have lower average prices than states where hospital outpatient departments dominate.
FAIR Health’s geographic benchmarking shows consistent 2x–3x variation in allowed amounts for CPT 45378 between the lowest-cost markets (parts of the Midwest and Southeast) and the highest-cost markets (major Northeast and West Coast metro areas).
Colonoscopy Costs by State (Typical In-Network Allowed Amount, CPT 45378)
| State | ASC (In-Network) | Hospital HOPD (In-Network) | Cash-Pay Range |
|---|---|---|---|
| New York | $1,400 – $2,600 | $2,400 – $4,200 | $1,200 – $3,500 |
| California | $1,200 – $2,400 | $2,000 – $4,000 | $1,000 – $3,200 |
| Florida | $900 – $1,800 | $1,600 – $3,200 | $800 – $2,400 |
| Texas | $900 – $1,900 | $1,500 – $3,000 | $700 – $2,200 |
| Illinois | $1,000 – $2,000 | $1,800 – $3,400 | $850 – $2,600 |
| Pennsylvania | $1,100 – $2,200 | $2,000 – $3,600 | $900 – $2,800 |
| Ohio | $750 – $1,600 | $1,400 – $2,800 | $700 – $2,000 |
| Georgia | $850 – $1,700 | $1,500 – $3,000 | $750 – $2,100 |
These are allowed-amount ranges from FAIR Health’s state benchmarking data and CMS facility data. Your actual out-of-pocket depends on your deductible status, network tier, and whether the procedure is coded as screening or diagnostic.
High-Cost States: New York and California
New York and California consistently show the highest colonoscopy prices in FAIR Health data. Hospital outpatient department allowed amounts in NYC frequently top $4,000 for the complete procedure including anesthesia. Freestanding ASCs in the outer boroughs or suburbs bring that number down to $1,400–$2,000.
California’s pricing is similarly elevated in the Bay Area and Los Angeles, but rural California can look more like Texas in terms of cost structure. The gap between a San Francisco hospital colonoscopy and a Fresno ASC colonoscopy can exceed $2,000 for the same CPT code.
Cash-pay patients in these states benefit most from specifically seeking freestanding ASCs and negotiating self-pay rates. The savings potential from ASC selection is highest in high-cost markets. See colonoscopy cost without insurance for negotiation tactics.
Moderate-Cost States: Illinois, Pennsylvania, Florida
These states sit in the middle of the national range. Illinois prices skew higher in the Chicago metropolitan area and lower in downstate regions — a gap that can exceed $800 for the same procedure. Pennsylvania shows similar Chicago/Philadelphia vs. rural variation.
Florida is notable for having a large Medicare-age population, which has pushed the ASC market to be very competitive — many freestanding ASCs in South Florida and the Tampa Bay area offer aggressive self-pay rates to capture uninsured patients and Medicare Advantage patients.
Lower-Cost States: Ohio, Georgia, Texas
Ohio consistently shows among the lowest colonoscopy prices in FAIR Health benchmarking. A straightforward screening colonoscopy at an Ohio ASC runs $750–$1,200 in allowed amounts. Cash-pay rates at competitive ASCs in Columbus or Cleveland can be found as low as $700 bundled.
Texas has lower average prices than most comparable states, driven by a large ASC market and competitive commercial insurance environment in major metros. Rural Texas is more variable — some markets have limited GI specialist supply which pushes prices up.
Georgia falls in the moderate-low range. Atlanta-area prices trend toward the national average, while rural Georgia — where GI specialists may be scarce — can run either cheaper (lower overhead) or more expensive (less competition).
How to Get State-Specific Price Data for Your Procedure
The most reliable sources for state-specific colonoscopy pricing:
- FAIR Health Consumer Cost Lookup (fairhealthconsumer.org) — free, ZIP-code-level cost data for any CPT code
- CMS Hospital Price Transparency — hospitals are required to publish standard charges, including the allowed amounts for commercial insurance by payer
- Your state’s all-payer claims database (APCD) — some states (CO, MA, NH, OR, WA) publish anonymized claims data with pricing information
- Your insurer’s cost estimator tool — most major insurers have online tools to estimate costs for specific procedures at specific facilities
What the Data Doesn’t Tell You
State averages mask important local variation. A ZIP code in rural Appalachian Ohio may have prices closer to urban Pennsylvania than to Columbus. A ZIP code in suburban New Jersey — technically near New York — may have much more moderate pricing than Manhattan.
Always get pricing data at the facility level, not the state level. FAIR Health’s consumer tool lets you enter your specific ZIP code and the exact CPT code (45378 for colonoscopy) to get cost benchmarks for your actual area.