CMS Price Transparency Data

Blood antibody screen

Facility: Lexington Memorial Hospital Inc

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $79
Cash Discount Price: $90
vs. Medicare Baseline: 1.48x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Lexington Memorial Hospital Inc is $79. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 1.48x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$79

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$53.24

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $53.24 (100%)

Cash / Self-Pay: $90 (169%)

Insurance Median: $79 (148%)

Cash: $90 (169% of Medicare)

Ins. Median: $79 (148% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $53.24 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.

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
Amerihealth	$21 - $27	39%
Carolina Complete	$21	39%
Healthy Blue	$21	39%
Partners	$21	39%
UnitedHealthcare	$21 - $80	39%
Vaya	$21	39%
Wellcare	$21	39%
Alliance	$22	41%
Trillium	$22	41%
Blue Cross Blue Shield	$26 - $42	49%
Ambetter / Centene	$27	51%
Medcost	$39 - $120	73%
Aetna	$51 - $165	96%
Oscar	$57 - $79	107%
Cigna	$78 - $79	147%
Directnet	$106	199%
Healthgram Lexington Home Brands	$129	242%
Healthgram	$143	269%
Private Healthcare Systems	$147	276%
Beechstreet	$158	297%
Humana	$158	297%
Multiplan	$161	302%
National Provider Network	$161	302%

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 $90.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 86850.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Lexington Memorial Hospital Inc is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 86850.
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.