CMS Price Transparency Data

CT scan, sinuses

Facility: Pender Memorial Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $577
Cash Discount Price: $792
vs. Medicare Baseline: 5.40x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Pender Memorial Hospital is $577. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $792. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 5.40x the Medicare baseline. Located in 507 E Fremont St, Burgaw, NC.

Cash / Self-Pay

$792

Average discount available for prompt cash payment at this facility.

Insurance Median

$577

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: $792 (742%)

Insurance Median: $577 (540%)

Cash: $792 (742% of Medicare)

Ins. Median: $577 (540% 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 540% of the Medicare baseline (a markup of 440%). 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	$219 - $752	205%
Humana	$380 - $1,753	356%
Pace Of The Southern Piedmont	$400 - $550	374%
New Hanover Health	$408 - $561	382%
Aetna	$410 - $1,732	384%
Cigna	$412 - $899	386%
Carolina Complete	$416 - $572	389%
Nc Department Of Public Safety	$416 - $1,101	389%
Amerihealth	$425 - $584	398%
Wellcare	$425 - $584	398%
Ambetter / Centene	$560 - $770	524%
Liberty Health	$568 - $782	532%
Caresource North Carolina	$593 - $815	555%
Plotkin Health	$889 - $1,223	832%
UnitedHealthcare	$1,082 - $1,488	1013%
Medcost	$1,116 - $1,710	1045%
Employers Choice Network	$1,438 - $1,977	1346%
Three Rivers Provider Network	$1,438 - $1,977	1346%

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 $792.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70486.

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 70486.
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.