CMS Price Transparency Data

Hepatitis C antibody test

Facility: Lexington Memorial Hospital Inc

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $110
  • Cash Discount Price: $125
  • vs. Medicare Baseline: 7.71x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at Lexington Memorial Hospital Inc is $110. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $125. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 7.71x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.
Cash / Self-Pay
$125

Average discount available for prompt cash payment at this facility.

Insurance Median
$110

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: $125 (876%)
Insurance Median: $110 (771%)
Cash: $125 (876% of Medicare)
Ins. Median: $110 (771% 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 771% of the Medicare baseline (a markup of 671%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Alliance $26 182%
Amerihealth $26 - $38 182%
Carolina Complete $26 182%
Healthy Blue $26 182%
Partners $26 182%
UnitedHealthcare $26 - $112 182%
Vaya $26 182%
Wellcare $26 182%
Trillium $27 189%
Blue Cross Blue Shield $36 - $59 252%
Ambetter / Centene $38 266%
Medcost $55 - $167 385%
Aetna $71 - $231 498%
Oscar $80 - $110 561%
Cigna $109 - $111 764%
Directnet $148 1037%
Healthgram Lexington Home Brands $180 1261%
Healthgram $200 1402%
Private Healthcare Systems $205 1437%
Beechstreet $220 1542%
Humana $220 1542%
Multiplan $225 1577%
National Provider Network $225 1577%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 250 Hospital Drive Po Box 1817, Lexington, NC 27293
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals