CMS Price Transparency Data

Hepatitis C antibody test

Facility: Modoc Medical Center

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $127
Cash Discount Price: $147
vs. Medicare Baseline: 8.90x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Modoc Medical Center is $127. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $147. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 8.90x the Medicare baseline. Located in 1111 N Nagle Street, Alturas, CA.

Cash / Self-Pay

$147

Average discount available for prompt cash payment at this facility.

Insurance Median

$127

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: $147 (1030%)

Insurance Median: $127 (890%)

Cash: $147 (1030% of Medicare)

Ins. Median: $127 (890% 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 890% of the Medicare baseline (a markup of 790%). 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
Integrated Hp Wc	$14	98%
Multiplan Wc	$14	98%
Ntwrks By Design Wc - All Plans	$14	98%
Adv Med Mgmt - All Plans	$16	112%
Medi-Cal	$16	112%
Medi-Cal 7/1/24	$16	112%
Partnership Hp - All Plans	$16	112%
Blue Shield Mcr Adv	$79	554%
Blue Shield Va	$79	554%
UnitedHealthcare	$79 - $139	554%
Tricare	$84	589%
Healthnet Mcr Adv	$85	596%
Blue Cross Blue Shield	$121 - $134	848%
Blue Shield Exch	$121	848%
Blue Shield Comm - All Other Plans	$134	939%
Carelon - All Plans	$134	939%
Corvel - All Plans	$138	967%
Aetna	$139	974%
Coventry/First Health - All Plans	$139	974%
Galaxy Health - All Plans	$139	974%
Healthnet Comm - All Other Plans	$139	974%
Hmn - All Plans	$139	974%
Integrated Hp - All Other Plans	$139	974%
Interplan - All Plans	$139	974%
Multiplan - All Other Plans	$139	974%
Superior Ca Ppo - All Plans	$139	974%

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 $147.
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 Modoc Medical Center 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.