CMS Price Transparency Data

Blood antibody screen

Facility: Pender Memorial Hospital

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $139
Cash Discount Price: $112
vs. Medicare Baseline: 2.61x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Pender Memorial Hospital is $139. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $112. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 2.61x the Medicare baseline. Located in 507 E Fremont St, Burgaw, NC.

Cash / Self-Pay

$112

Average discount available for prompt cash payment at this facility.

Insurance Median

$139

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$53.24

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $53.24 (100%)

Cash / Self-Pay: $112 (210%)

Insurance Median: $139 (261%)

Cash: $112 (210% of Medicare)

Ins. Median: $139 (261% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $53.24 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 261% of the Medicare baseline (a markup of 161%). 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
Humana	$50 - $282	94%
Blue Cross Blue Shield	$52 - $236	98%
Pace Of The Southern Piedmont	$52 - $89	98%
Aetna	$53 - $279	100%
New Hanover Health	$53 - $90	100%
Carolina Complete	$54 - $92	101%
Cigna	$54 - $145	101%
Nc Department Of Public Safety	$54 - $177	101%
Amerihealth	$55 - $94	103%
Wellcare	$55 - $94	103%
Ambetter / Centene	$73 - $124	137%
Liberty Health	$74 - $126	139%
Caresource North Carolina	$77 - $131	145%
Plotkin Health	$116 - $197	218%
UnitedHealthcare	$141 - $239	265%
Medcost	$145 - $275	272%
Employers Choice Network	$187 - $318	351%
Three Rivers Provider Network	$187 - $318	351%

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 $112.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 86850.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Pender Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 86850.
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.