How much does a colonoscopy cost in Utah? A Utah Department of Health report shows a median amount allowed by commercial insurance companies of $1,761 for a colonoscopy done between July 2019 and June 2020. Clinics allowed amounts were lower compared to Ambulatory Surgery settings. These were in turn lower than in Hospital Outpatient settings. Costs went up about $200 with each more sophisticated setting.
The report compares prices and median allowed payments for 61 locations: 9 clinics, 12 ambulatory surgery centers, and 40 hospital outpatient locations.
The lowest allowed amount at a location that had at least 500 procedures (on commercially insured patients) was Ridgeline Surgicenter in Ogden. The Ridgeline median charge of $7,209 compares to the allowed median of just $1,405. The 15 locations that did at least 500 procedures performed 80% of all the commercial insurance colonoscopies in Utah. Of the large centers, Bountiful Surgery Center and Wasatch Endoscopy Center had median charges near $8,000 for a colonoscopy. Granite Peaks Gastroenterology had the smallest gap between charges and allowed amounts. They accepted $1,446 as the median payment amount, on median charges of just $2,661.
The Utah report shows the wide gap between prices and allowed amounts that actually get paid. Nine colonoscopy locations had an average charge over $7,000. The report found median charges could be as high as $8,134, at Utah Surgery Center. But this ambulatory surgery center accepted on average, an allowed price of $1,900. That is effectively a 77% discount off charges. Ambulatory surgery centers tended to charge more than hospitals, then offer larger discounts. Insurance companies appeared to have a maximum allowed charge (up to $3,730), despite the billing price. Discounts vary by insurance plan. The most expensive location paid by commercial insurance was San Juan Health Services District hospital, which did just 17 commercial insurance procedures. Their median allowed amount was $3,279. Of the large centers, University Hospitals and Clinics (2,417 procedures) had the highest median allowed cost of $2,253. Sixteen locations across the state had allowed costs higher than University Hospital.
CPT codes 45385, 45380 and 45378 were used in the study, along with associated anesthesia, surgeon or GI physician, pathology, and procedure costs. These codes covered over 95% of all colonoscopies on commercial patients. Additional details such as volume, and actual numbers for each provider are in Utah’s OpenData Catalog linked in the report. Medicare patients and quality indicators were not included in the study. Published by the Office of Healthcare Statistics, March 2021.