Cologuard is unusual among cash-pay medical products because the company that makes it publishes one price and sticks to it. There is no chargemaster to decode, no facility fee, and no separate reading charge. Exact Sciences lists a single self-pay number on its own website, and an independent cash-pay screening program charges the identical amount.
That simplicity ends the moment the test comes back positive. This guide covers the published 2026 self-pay price for Cologuard Plus, what Medicare and commercial plans actually pay, how the price compares to the much cheaper FIT stool tests and the much more expensive colonoscopy, and the one line item most people forget to budget for.
What Does Cologuard Cost Without Insurance?
Figures below are published cash prices as of September 2026, read directly from each seller’s own pricing page. Cologuard Plus is the current version of the test, approved by the FDA on October 4, 2024, and it is what Exact Sciences ships to new self-pay customers.
| Service / Type | Low | Average | High |
|---|---|---|---|
| Cologuard Plus, published self-pay price | n/a | $599 | n/a |
| Cologuard through the ColonoscopyAssist cash program | n/a | $599 | n/a |
| Cologuard with manufacturer patient assistance (at or below 400% FPL) | $0 | n/a | n/a |
| Cologuard with Medicare Part B or most commercial plans | $0 | n/a | n/a |
| FIT stool test, ColonoscopyAssist cash program | n/a | $25 | n/a |
| FIT stool test, Quest Diagnostics home kit | n/a | $85 | n/a |
| FIT stool test, Labcorp OnDemand ColoFIT kit | n/a | $89 | n/a |
| Follow-up screening colonoscopy, all-inclusive cash rate | $1,075 | n/a | n/a |
Sources: the $599 self-pay price and the patient assistance program are published by Exact Sciences on the Cologuard insurance and cost page; the second $599, the $25 FIT, and the $1,075 all-inclusive colonoscopy come from ColonoscopyAssist’s own rate card; the Quest figure is $79 plus a $6 physician service fee on questhealth.com; $89 is Labcorp OnDemand’s listed ColoFIT price; the $0 insured figure reflects Exact Sciences’ statement that most insured patients pay nothing and CMS coverage under NCD 210.3.
The two independent sources for the Cologuard cash price agree exactly, which is rare in healthcare pricing and tells you something useful: $599 is a real retail price rather than an opening bid. Exact Sciences does not publish a separate list or billed price for self-pay customers, so there is no inflated number to negotiate down from.
What Drives the Price
Whether anyone is billing your insurance
This is the whole ballgame. Exact Sciences states that most insured patients pay $0, and its self-pay price only applies when no plan is being billed. If you have coverage and the claim goes through normally, your out-of-pocket cost is usually nothing. If you are uninsured, or your plan denies the claim, you land on the $599 number.
Which version of the test you get
Cologuard Plus is the current product and the one sold at the $599 self-pay price. Exact Sciences notes that patients whose insurance plans do not yet cover Cologuard Plus may instead be prescribed the original Cologuard test. Both are FDA-approved and both are covered by Medicare Part B, so from a cash-price perspective the distinction rarely changes what you pay.
Your income
The manufacturer runs a patient assistance program for households at or below 400 percent of the federal poverty level. Qualifying can bring the test to no cost. Exact Sciences says enrollment in Medicaid, SNAP, SSI, or a home energy assistance program may be enough on its own to establish eligibility, which removes the usual income-documentation hurdle.
How you order it
Cologuard is prescription only. You can get the order from your own clinician, or use the telehealth route Exact Sciences runs with Recuro Health. Both paths end at the same test price, but the telehealth path avoids an office visit charge if you would otherwise be paying cash for the appointment too.
What you are actually comparing it to
The $599 looks expensive next to a FIT kit and cheap next to a colonoscopy, and both comparisons are fair. The USPSTF lists annual FIT, stool DNA-FIT every one to three years, and colonoscopy every ten years as separate strategies with different cadences, so the honest comparison is cost per year of coverage rather than cost per test.
Cash Price vs. Insurance
For most tests on this site, the advice is to check whether the cash price beats your negotiated rate. For Cologuard the answer is almost always no, because the insured price is usually zero.
Medicare’s position is explicit. CMS National Coverage Determination 210.3, in the version effective June 8, 2026, covers non-invasive biomarker colorectal cancer screening tests once every three years for beneficiaries aged 45 to 85 who are asymptomatic and at average risk, when ordered by a physician, physician assistant, nurse practitioner, or clinical nurse specialist. Exact Sciences states the test carries no copay or deductible for eligible Medicare Part B members.
Commercial coverage follows the USPSTF. The task force gives colorectal cancer screening an A grade for adults aged 50 to 75 and a B grade for adults aged 45 to 49, and it names stool DNA-FIT every one to three years as a recommended strategy. A and B recommendations trigger the ACA preventive-services rule, which is why Exact Sciences can say most insured patients pay $0 and why the company also notes that eligible out-of-network patients aged 45 to 75 should still be covered without a copay or deductible.
The practical consequence: if you have any coverage at all, ask Exact Sciences to bill it before you reach for the self-pay option. The company runs an insurance-lookup tool and a billing line for exactly this. Paying $599 cash when a claim would have paid in full is the most common way to overspend on this test.
The Follow-Up Colonoscopy Is the Real Budget Risk
A positive Cologuard result is not a diagnosis. It is a referral to a colonoscopy, and that is a far bigger bill. Through ColonoscopyAssist, an all-inclusive cash screening or diagnostic colonoscopy starts at $1,075. Priced conventionally it runs much higher, which our colonoscopy cost guide breaks down by facility type.
If you are insured, federal guidance protects you here. In FAQs About Affordable Care Act Implementation Part 51, the Departments of Labor, Health and Human Services, and the Treasury stated that a plan must cover, and may not impose cost sharing on, a colonoscopy performed after a positive non-invasive stool-based screening test, on the reasoning that the follow-up scope is an integral part of the screening. Exact Sciences confirms the same is true of Medicare and commercial plans as of 2023.
If you are uninsured and paying cash, that protection does not exist and the arithmetic changes. A $599 stool test that can send you on to a $1,000-plus procedure is a different purchase than a $599 test in isolation. CMS built this into the coverage rule itself: the June 2026 version of NCD 210.3 requires that patients be given information about test performance and about the importance of a follow-on colonoscopy if the result is positive. Price that colonoscopy before you buy the screen, not after.
How to Pay Less
- Let them bill your insurance first. Use the insurer lookup on the Cologuard site or call the billing line before choosing self-pay. The $599 is a fallback, not a default.
- Apply for patient assistance if your household is at or below 400 percent of FPL. Exact Sciences may provide the test at no cost, and existing enrollment in Medicaid, SNAP, or SSI can substitute for income paperwork.
- Compare against an annual FIT. At $25 through ColonoscopyAssist, $85 at Quest, and $89 at Labcorp OnDemand, a FIT kit costs a small fraction of Cologuard. Both are stool-based screens the USPSTF lists as recommended strategies, and a community health center may run one for even less. Our guide to free clinics and sliding-scale care covers how to find one.
- Pay with pretax dollars. The Cologuard self-pay cost is eligible for FSA, HSA, and HRA reimbursement, which quietly cuts the real price by your marginal tax rate. Quest and Labcorp accept HSA and FSA on their FIT kits too.
- Sanity-check any quote above $599. If a clinic or health system quotes more, you are being charged for something beyond the test. Run the number through our fair price checker and compare it against the posted cash rate using our hospital price transparency guide.
- If a surprise bill shows up, work it. Request an itemized bill first, then use our medical bill negotiation guide to bring it back to the published $599. For a large follow-up colonoscopy balance, check our hospital charity care guide.
How It Compares to Other Screening Options
Priced per test, the ladder runs from about $25 for a FIT kit to $599 for Cologuard to $1,075 and up for a colonoscopy. Priced per year of screening coverage, the gap narrows considerably, because a FIT is repeated annually, Cologuard every three years, and a colonoscopy every ten.
Cologuard also sits in a different regulatory world than the newer cash-pay cancer screens. It is FDA-approved, written into Medicare’s national coverage policy, and named in the USPSTF strategy list. A blood-based multi-cancer test like the one covered in our Galleri test cost guide is none of those things, which is why it costs more and is paid for almost entirely out of pocket. If you are budgeting for routine lab work alongside screening, our blood work cost guide covers direct-to-consumer panel pricing.
This is a cost guide, not medical guidance. Which colorectal screening strategy fits you is a conversation for a clinician. What each one costs, and who pays, is what this page is for.
Bottom Line
Cologuard is a $599 cash purchase and a $0 purchase for most insured patients, with a well-defined assistance program for lower-income households in between. The price is published, consistent across two independent sellers, and not really negotiable, which makes this one of the easier healthcare purchases to plan for. The number that deserves your attention is not the $599. It is the colonoscopy waiting behind a positive result, and whether you have coverage that will absorb it.