CMS Price Transparency Data

Blood test, lipase

Facility: Pender Memorial Hospital

Billing Code: 83690 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 83690
Insurance Median: $101
Cash Discount Price: $111
vs. Medicare Baseline: 14.66x Medicare

The contracted insurance negotiated median rate for a Blood test, lipase at Pender Memorial Hospital is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111. Compared to the federal Medicare reimbursement reference rate of $6.89, this hospital’s rate is 14.66x the Medicare baseline. Located in 507 E Fremont St, Burgaw, NC.

Cash / Self-Pay

$111

Average discount available for prompt cash payment at this facility.

Insurance Median

$101

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$6.89

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $6.89 (100%)

Cash / Self-Pay: $111 (1611%)

Insurance Median: $101 (1466%)

Cash: $111 (1611% of Medicare)

Ins. Median: $101 (1466% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $6.89 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 1466% of the Medicare baseline (a markup of 1366%). 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	$31 - $322	450%
Blue Cross Blue Shield	$32 - $270	464%
Pace Of The Southern Piedmont	$32 - $101	464%
Aetna	$33 - $319	479%
Carolina Complete	$33 - $105	479%
Cigna	$33 - $165	479%
Nc Department Of Public Safety	$33 - $202	479%
New Hanover Health	$33 - $103	479%
Amerihealth	$34 - $107	493%
Wellcare	$34 - $107	493%
Ambetter / Centene	$45 - $142	653%
Liberty Health	$46 - $144	668%
Caresource North Carolina	$48 - $150	697%
Plotkin Health	$71 - $225	1030%
UnitedHealthcare	$87 - $274	1263%
Medcost	$90 - $315	1306%
Employers Choice Network	$115 - $364	1669%
Three Rivers Provider Network	$115 - $364	1669%

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 $111.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 83690.

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 83690.
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.