CMS Price Transparency Data

Colonoscopy (diagnostic)

Facility: Lawrence Memorial Hospital

Billing Code: 45378 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45378
Insurance Median: $430
Cash Discount Price: $509
vs. Medicare Baseline: 0.45x Medicare

The contracted insurance negotiated median rate for a Colonoscopy (diagnostic) at Lawrence Memorial Hospital is $430. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $509. Compared to the federal Medicare reimbursement reference rate of $950.1, this hospital’s rate is 0.45x the Medicare baseline. Located in 1309 West Main Street, Walnut Ridge, AR.

Cash / Self-Pay

$509

Average discount available for prompt cash payment at this facility.

Insurance Median

$430

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$950.1

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $950.1 (100%)

Cash / Self-Pay: $509 (54%)

Insurance Median: $430 (45%)

Cash: $509 (54% of Medicare)

Ins. Median: $430 (45% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $950.1 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.

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
Humana	$83 - $533	9%
Ambetter / Centene	$85 - $685	9%
Blue Cross Blue Shield	$85 - $845	9%
Arkansas Total Care	$86 - $429	9%
Arkansas Superior Select	$88 - $515	9%
Provider Partners Health Plans	$88 - $515	9%
Wellcare By Allwell	$88 - $515	9%
Wellcare Health Plans	$88 - $515	9%
Caresource	$89 - $578	9%
Qualchoice Of Arkansas	$96 - $637	10%
Cigna	$100 - $527	11%
Covenant Healthcare	$108 - $1,250	11%
Assured Benefits Administrators	$134 - $784	14%
Allwell	$153 - $554	16%
Wellcare	$153 - $925	16%
Amerigroup	$155 - $527	16%
Qualchoice	$168 - $685	18%
Empower Healthcare Solutions	$262 - $450	28%
Aetna	$604 - $740	64%
Healthlink	$702 - $860	74%

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 $509.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45378.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Lawrence Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45378.
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.