CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Lawrence Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $540
Cash Discount Price: $634
vs. Medicare Baseline: 0.44x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Lawrence Memorial Hospital is $540. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $634. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 0.44x the Medicare baseline. Located in 1309 West Main Street, Walnut Ridge, AR.

Cash / Self-Pay

$634

Average discount available for prompt cash payment at this facility.

Insurance Median

$540

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: $634 (52%)

Insurance Median: $540 (44%)

Cash: $634 (52% of Medicare)

Ins. Median: $540 (44% 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.

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
Arkansas Total Care	$93 - $465	8%
Caresource	$97 - $578	8%
Ambetter / Centene	$177 - $848	14%
Amerigroup	$177 - $653	14%
Humana	$177 - $659	14%
Blue Cross Blue Shield	$185 - $1,101	15%
Allwell	$186 - $685	15%
Wellcare	$186 - $1,145	15%
Arkansas Superior Select	$190 - $637	16%
Provider Partners Health Plans	$190 - $637	16%
Wellcare By Allwell	$190 - $637	16%
Wellcare Health Plans	$190 - $637	16%
Qualchoice	$203 - $848	17%
Qualchoice Of Arkansas	$209 - $789	17%
Cigna	$212 - $653	17%
Covenant Healthcare	$234 - $1,250	19%
Empower Healthcare Solutions	$262 - $489	21%
Assured Benefits Administrators	$290 - $971	24%
Aetna	$758 - $916	62%
Healthlink	$881 - $1,065	72%

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 $634.
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 Lawrence Memorial 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.