CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Pender Memorial Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $984
Cash Discount Price: $1,154
vs. Medicare Baseline: 4.04x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Pender Memorial Hospital is $984. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,154. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 4.04x the Medicare baseline. Located in 507 E Fremont St, Burgaw, NC.

Cash / Self-Pay

$1,154

Average discount available for prompt cash payment at this facility.

Insurance Median

$984

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $1,154 (473%)

Insurance Median: $984 (404%)

Cash: $1,154 (473% of Medicare)

Ins. Median: $984 (404% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 404% of the Medicare baseline (a markup of 304%). 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	$419 - $1,298	172%
Humana	$628 - $3,025	258%
Pace Of The Southern Piedmont	$661 - $950	271%
New Hanover Health	$674 - $969	276%
Aetna	$678 - $2,990	278%
Cigna	$681 - $1,551	279%
Carolina Complete	$688 - $988	282%
Nc Department Of Public Safety	$688 - $1,900	282%
Amerihealth	$701 - $1,008	288%
Wellcare	$701 - $1,008	288%
Ambetter / Centene	$925 - $1,330	379%
Liberty Health	$939 - $1,349	385%
Caresource North Carolina	$979 - $1,407	402%
Plotkin Health	$1,469 - $2,111	603%
UnitedHealthcare	$1,787 - $2,568	733%
Medcost	$1,843 - $2,952	756%
Employers Choice Network	$2,375 - $3,412	974%
Three Rivers Provider Network	$2,375 - $3,412	974%

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 $1,154.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 73721.

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 73721.
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.