CMS Price Transparency Data

Hepatitis C antibody test

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $74
  • Cash Discount Price: $41
  • vs. Medicare Baseline: 5.19x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at Carilion Stonewall Jackson Hospital is $74. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 5.19x the Medicare baseline. Located in 1 Health Circle, Lexington, VA.
Cash / Self-Pay
$41

Average discount available for prompt cash payment at this facility.

Insurance Median
$74

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: $41 (287%)
Insurance Median: $74 (519%)
Cash: $41 (287% of Medicare)
Ins. Median: $74 (519% 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 519% of the Medicare baseline (a markup of 419%). 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 $15 105%
Sentara Health Plan $15 - $72 105%
Abh of VA (Formerly Coventry) $16 112%
Abh of Wva (Formerly Coventry) $16 112%
Humana $16 112%
UnitedHealthcare $16 - $95 112%
Aetna $59 - $77 413%
Gateway - Tier 3 $64 448%
Vhn - Ultra $72 505%
Connecticare $81 568%
Cigna $93 652%
Gateway - Tier 2 $93 652%
Vhn - Plus $93 652%
Integrated Health Plan $99 694%
Vhn $99 694%
Vhn - Link $104 729%
Beech Street $107 750%
Gateway - Tier 1 $110 771%
Vhn - Secondary Payors $110 771%

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