CMS Price Transparency Data

Hepatitis C antibody test

Facility: Pender Memorial Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $117
Cash Discount Price: $86
vs. Medicare Baseline: 8.20x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Pender Memorial Hospital is $117. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 8.20x the Medicare baseline. Located in 507 E Fremont St, Burgaw, NC.

Cash / Self-Pay

$86

Average discount available for prompt cash payment at this facility.

Insurance Median

$117

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14.27

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14.27 (100%)

Cash / Self-Pay: $86 (603%)

Insurance Median: $117 (820%)

Cash: $86 (603% of Medicare)

Ins. Median: $117 (820% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14.27 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 820% of the Medicare baseline (a markup of 720%). 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	$48 - $169	336%
Blue Cross Blue Shield	$51 - $141	357%
Pace Of The Southern Piedmont	$51 - $53	357%
Aetna	$52 - $167	364%
Cigna	$52 - $86	364%
New Hanover Health	$52 - $54	364%
Carolina Complete	$53 - $55	371%
Nc Department Of Public Safety	$53 - $106	371%
Amerihealth	$54 - $56	378%
Wellcare	$54 - $56	378%
Ambetter / Centene	$71 - $74	498%
Liberty Health	$72 - $75	505%
Caresource North Carolina	$75 - $78	526%
Plotkin Health	$113 - $118	792%
UnitedHealthcare	$137 - $143	960%
Medcost	$142 - $164	995%
Employers Choice Network	$182 - $190	1275%
Three Rivers Provider Network	$182 - $190	1275%

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 $86.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 86803.

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 86803.
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.