CMS Price Transparency Data

Hepatitis C antibody test

Facility: Stephens County Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $34
  • Cash Discount Price: $52
  • vs. Medicare Baseline: 2.38x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at Stephens County Hospital is $34. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $52. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 2.38x the Medicare baseline. Located in 163 Hospital Drive, Toccoa, GA.
Cash / Self-Pay
$52

Average discount available for prompt cash payment at this facility.

Insurance Median
$34

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: $52 (364%)
Insurance Median: $34 (238%)
Cash: $52 (364% of Medicare)
Ins. Median: $34 (238% 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 238% of the Medicare baseline (a markup of 138%). 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
Amerigroup $10 70%
Medicaid / KanCare $10 70%
Medicare (plans) $14 98%
Caresource $15 105%
Blue Cross Blue Shield $32 - $107 224%
Aetna $34 - $114 238%
UnitedHealthcare $35 - $118 245%
Cigna $36 - $121 252%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 163 Hospital Drive, Toccoa, GA 30577
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Acute Care Hospitals