CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Pender Memorial Hospital

Billing Code: 99213 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$139

about 1.5× the $95 Medicare rate · typically $105–$212

modeled estimate · not a bill or quote

What this hospital charges insurers

$124

Below the fair price — a good deal

about $15 under the fair price · 1.3× Medicare

Medicare pays $95 Fair price $139 This hospital $124 Cash price $119 Hospital's list price $266

How we calculate the fair BaseRate →

How this hospital compares to other NC hospitals

Highest price of the 9 NC hospitals we have prices for — worth calling around.

Cheapest $41 Priciest $124

Black dot = this hospital, among the 9 NC hospitals with a price for this procedure. Full list below.

A fair price for a Office visit, established patient (20-29 min) is about $139 (about 1.5× the $95 Medicare rate). Pender Memorial Hospital charges insurers about $124, or about $119 in cash — below the fair price — a good deal. Located in Burgaw, NC.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$125 - $263	131%
Blue Cross Blue Shieldmajor	$46 - $259	48%
Aetnamajor	$47 - $306	49%
Cignamajor	$48 - $159	50%
Humanamajor	$44 - $310	46%
Ambetter (Centene)	$65 - $136	68%
AmeriHealth	$49 - $103	51%
CareSource	$68 - $144	71%
WellCare	$49 - $103	51%
+ 7 smaller / regional plans	$46 - $349

Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 119), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 99213.

Insurance Before you use insurance

Call your insurance company to confirm Pender Memorial Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 99213.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Pender Memorial Hospital

Compare: Office visit, established patient (20-29 min) at other NC hospitals

Insurance negotiated median for the same procedure, sorted lowest first.