CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Lexington Memorial Hospital Inc

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $103
Cash Discount Price: $117
vs. Medicare Baseline: 9.75x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Lexington Memorial Hospital Inc is $103. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $117. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 9.75x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$117

Average discount available for prompt cash payment at this facility.

Insurance Median

$103

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.56 (100%)

Cash / Self-Pay: $117 (1108%)

Insurance Median: $103 (975%)

Cash: $117 (1108% of Medicare)

Ins. Median: $103 (975% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $10.56 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 975% of the Medicare baseline (a markup of 875%). 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
Amerihealth	$15 - $35	142%
Carolina Complete	$15	142%
Healthy Blue	$15	142%
Partners	$15	142%
Alliance	$16	152%
Trillium	$16	152%
UnitedHealthcare	$16 - $105	152%
Vaya	$16	152%
Wellcare	$16	152%
Blue Cross Blue Shield	$34 - $55	322%
Ambetter / Centene	$36	341%
Medcost	$51 - $157	483%
Aetna	$66 - $216	625%
Oscar	$75 - $103	710%
Cigna	$102 - $104	966%
Directnet	$138	1307%
Healthgram Lexington Home Brands	$168	1591%
Healthgram	$187	1771%
Private Healthcare Systems	$192	1818%
Beechstreet	$206	1951%
Humana	$206	1951%
Multiplan	$211	1998%
National Provider Network	$211	1998%

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 $117.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 80053.

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 80053.
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.