CMS Price Transparency Data

Blood antibody screen

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86850
  • Insurance Median: $200
  • Cash Discount Price: $125
  • vs. Medicare Baseline: 3.76x Medicare
The contracted insurance negotiated median rate for a Blood antibody screen at Carilion Stonewall Jackson Hospital is $200. 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 $53.24, this hospital’s rate is 3.76x the Medicare baseline. Located in 1 Health Circle, Lexington, VA.
Cash / Self-Pay
$125

Average discount available for prompt cash payment at this facility.

Insurance Median
$200

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: $125 (235%)
Insurance Median: $200 (376%)
Cash: $125 (235% of Medicare)
Ins. Median: $200 (376% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 376% of the Medicare baseline (a markup of 276%). 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
Blue Cross Blue Shield $4 - $243 8%
Sentara Health Plan $4 - $221 8%
Humana $5 - $50 9%
Abh of Wva (Formerly Coventry) $5 9%
Abh of VA (Formerly Coventry) $5 9%
UnitedHealthcare $5 - $292 9%
Aetna $46 - $237 86%
Gateway - Tier 3 $196 368%
Vhn - Ultra $221 415%
Connecticare $250 470%
Vhn - Plus $286 537%
Gateway - Tier 2 $286 537%
Cigna $286 537%
Integrated Health Plan $303 569%
Vhn $303 569%
Vhn - Link $321 603%
Beech Street $328 616%
Vhn - Secondary Payors $339 637%
Gateway - Tier 1 $339 637%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1 Health Circle, Lexington, VA 24450
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals