CMS Price Transparency Data

Blood test, sodium

Facility: Pender Memorial Hospital

Billing Code: 84295 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84295
Insurance Median: $44
Cash Discount Price: $39
vs. Medicare Baseline: 9.15x Medicare

The contracted insurance negotiated median rate for a Blood test, sodium at Pender Memorial Hospital is $44. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $39. Compared to the federal Medicare reimbursement reference rate of $4.81, this hospital’s rate is 9.15x the Medicare baseline. Located in 507 E Fremont St, Burgaw, NC.

Cash / Self-Pay

$39

Average discount available for prompt cash payment at this facility.

Insurance Median

$44

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$4.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $4.81 (100%)

Cash / Self-Pay: $39 (811%)

Insurance Median: $44 (915%)

Cash: $39 (811% of Medicare)

Ins. Median: $44 (915% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $4.81 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 915% of the Medicare baseline (a markup of 815%). 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	$16 - $95	333%
Aetna	$17 - $94	353%
Blue Cross Blue Shield	$17 - $80	353%
New Hanover Health	$17 - $31	353%
Pace Of The Southern Piedmont	$17 - $30	353%
Amerihealth	$18 - $32	374%
Carolina Complete	$18 - $31	374%
Cigna	$18 - $49	374%
Nc Department Of Public Safety	$18 - $60	374%
Wellcare	$18 - $32	374%
Ambetter / Centene	$24 - $42	499%
Liberty Health	$24 - $43	499%
Caresource North Carolina	$25 - $44	520%
Plotkin Health	$38 - $67	790%
UnitedHealthcare	$46 - $81	956%
Medcost	$47 - $93	977%
Employers Choice Network	$61 - $108	1268%
Three Rivers Provider Network	$61 - $108	1268%

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 $39.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 84295.

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 84295.
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.