CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Monument Health Rapid City Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $4,256
Cash Discount Price: $7,085
vs. Medicare Baseline: 3.48x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Monument Health Rapid City Hospital is $4,256. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,085. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 3.48x the Medicare baseline. Located in 353 Fairmont Blvd, Rapid City, SD.

Cash / Self-Pay

$7,085

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,256

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$1,222.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $1,222.56 (100%)

Cash / Self-Pay: $7,085 (580%)

Insurance Median: $4,256 (348%)

Cash: $7,085 (580% of Medicare)

Ins. Median: $4,256 (348% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $1,222.56 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 348% of the Medicare baseline (a markup of 248%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Cross Blue Shield	$1,205 - $2,993	99%
Healthpartners [3081368]	$1,205	99%
Humana	$1,205 - $6,377	99%
Medicare (plans)	$1,205	99%
Tricare	$1,205	99%
UnitedHealthcare	$1,205 - $4,256	99%
Va Black Hills Health Care System 12115 [3081206]	$1,205	99%
Minnesota Health Care Programs 12K16 [3081295]	$2,147	176%
Risk Admin Svs [3081167]	$3,509	287%
Health Partners Sx009 [3081102]	$3,860	316%
Govt Employees Health Assn [3081090]	$4,256	348%
National Telephone Cooperative Assn 52103 [3081149]	$4,256	348%
Surest [3081369]	$4,256	348%
United Medical Resources 39026 [3081194]	$4,256	348%
Avera Health Plans 46045 [3081018]	$4,491	367%
Coresource 38225 [3081146]	$4,606	377%
Sanford Health Plan 91184 [3081174]	$5,499	450%
Group And Pension Administrators Inc [3081098]	$5,594	458%
Multiplan Inc 34080 [3081285]	$5,594	458%
Rocky Mountain Admin Llc 83028 [3081168]	$5,668	464%
Medica (Commercial) 94265 [3081118]	$5,881	481%
Employee Benefit Management 12X44 [3081079]	$6,023	493%
Pacificsource Health Plans [3081333]	$6,023	493%
Aetna	$6,377	522%
Tlc Advantage Llc [3081189]	$6,660	545%
Fedmed Inc [3081283]	$6,731	551%
Allied Benefit Systems Inc [3081320]	$6,802	556%
Cigna	$6,802	556%
Key Benefit Administrators [3081332]	$6,802	556%
Meritain Health [3081135]	$6,802	556%
Midlands Choice 47080 [3081136]	$6,802	556%
Preferred One 41147 [3081160]	$6,802	556%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $7,085.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45380.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Monument Health Rapid City Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45380.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.