CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Pender Memorial Hospital

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $97
Cash Discount Price: $81
vs. Medicare Baseline: 9.19x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Pender Memorial Hospital is $97. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $81. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 9.19x the Medicare baseline. Located in 507 E Fremont St, Burgaw, NC.

Cash / Self-Pay

$81

Average discount available for prompt cash payment at this facility.

Insurance Median

$97

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.56 (100%)

Cash / Self-Pay: $81 (767%)

Insurance Median: $97 (919%)

Cash: $81 (767% of Medicare)

Ins. Median: $97 (919% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $10.56 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 919% of the Medicare baseline (a markup of 819%). 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	$35 - $193	331%
Blue Cross Blue Shield	$37 - $161	350%
Pace Of The Southern Piedmont	$37 - $60	350%
Aetna	$38 - $190	360%
Cigna	$38 - $99	360%
New Hanover Health	$38 - $62	360%
Carolina Complete	$39 - $63	369%
Nc Department Of Public Safety	$39 - $121	369%
Amerihealth	$40 - $64	379%
Wellcare	$40 - $64	379%
Ambetter / Centene	$52 - $85	492%
Liberty Health	$53 - $86	502%
Caresource North Carolina	$55 - $90	521%
Plotkin Health	$83 - $134	786%
UnitedHealthcare	$101 - $164	956%
Medcost	$104 - $188	985%
Employers Choice Network	$134 - $217	1269%
Three Rivers Provider Network	$134 - $217	1269%

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 $81.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 80053.

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 80053.
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.