CMS Price Transparency Data

Hepatitis C antibody test

Facility: Mayers Memorial Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $168
Cash Discount Price: $197
vs. Medicare Baseline: 11.77x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Mayers Memorial Hospital is $168. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $197. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 11.77x the Medicare baseline. Located in 43563 Hwy 299 East, Fall River Mills, CA.

Cash / Self-Pay

$197

Average discount available for prompt cash payment at this facility.

Insurance Median

$168

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: $197 (1381%)

Insurance Median: $168 (1177%)

Cash: $197 (1381% of Medicare)

Ins. Median: $168 (1177% 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 1177% of the Medicare baseline (a markup of 1077%). 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
Medi-Cal	$16	112%
Partnership Hp-All Plans	$16	112%
Blue Shield Ca Va	$124	869%
Blue Shield Mcr Adv	$124	869%
Arcadian Health Services-All Plans	$130	911%
Health Net Mcr Adv	$130	911%
Tricare	$130	911%
Blue Cross Blue Shield	$131 - $168	918%
Health Net Prison	$142	995%
Imperial Health Plan-All Plans	$147	1030%
Blue Shield Ca Exchange	$168	1177%
Blue Shield-All Other Plans	$187	1310%
Cigna	$187	1310%
Corvel Ppo-All Plans	$187	1310%
Coventry/First Health-All Plans	$187	1310%
Hmn-All Plans	$187	1310%
Integrated Hp-All Plans	$187	1310%
Interplan-All Plans	$187	1310%
Multiplan Phcs-All Plans	$187	1310%
Pfmc-All Plans	$187	1310%
Superior Ca-All Plans	$187	1310%
Health Net-All Other Plans	$196	1374%
Pacificare-All Plans	$197	1381%

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 $197.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 86803.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mayers Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 86803.
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.