CMS Price Transparency Data

CT scan, pelvis

Facility: Pender Memorial Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $638
Cash Discount Price: $859
vs. Medicare Baseline: 5.97x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Pender Memorial Hospital is $638. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $859. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.97x the Medicare baseline. Located in 507 E Fremont St, Burgaw, NC.

Cash / Self-Pay

$859

Average discount available for prompt cash payment at this facility.

Insurance Median

$638

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $859 (804%)

Insurance Median: $638 (597%)

Cash: $859 (804% of Medicare)

Ins. Median: $638 (597% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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 597% of the Medicare baseline (a markup of 497%). 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
Blue Cross Blue Shield	$208 - $772	195%
Humana	$443 - $1,798	415%
Pace Of The Southern Piedmont	$467 - $565	437%
New Hanover Health	$476 - $576	446%
Aetna	$478 - $1,777	448%
Cigna	$481 - $922	450%
Carolina Complete	$485 - $587	454%
Nc Department Of Public Safety	$485 - $1,129	454%
Amerihealth	$495 - $599	463%
Wellcare	$495 - $599	463%
Ambetter / Centene	$653 - $790	611%
Liberty Health	$663 - $802	621%
Caresource North Carolina	$691 - $836	647%
Plotkin Health	$1,037 - $1,255	971%
UnitedHealthcare	$1,261 - $1,526	1181%
Medcost	$1,301 - $1,754	1218%
Employers Choice Network	$1,676 - $2,028	1569%
Three Rivers Provider Network	$1,676 - $2,028	1569%

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 $859.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72192.

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 72192.
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.