CMS Price Transparency Data

Hepatitis C antibody test

Facility: Mercyone Clinton Medical Center

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $257
  • Cash Discount Price: $191
  • vs. Medicare Baseline: 18.01x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at Mercyone Clinton Medical Center is $257. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $191. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 18.01x the Medicare baseline. Located in 1410 North 4Th Street, Clinton, IA.
Cash / Self-Pay
$191

Average discount available for prompt cash payment at this facility.

Insurance Median
$257

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: $191 (1338%)
Insurance Median: $257 (1801%)
Cash: $191 (1338% of Medicare)
Ins. Median: $257 (1801% 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 1801% of the Medicare baseline (a markup of 1701%). 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
Aetna $14 - $257 98%
Blue Cross Blue Shield $14 98%
Geha $14 98%
Iowa Total Care $14 98%
Medicaid / KanCare $14 98%
Medicare (plans) $14 - $15 98%
UnitedHealthcare $14 - $294 98%
Amish Hospital Aid $19 133%
Oscar $19 133%
Ambetter / Centene $24 168%
Claimdoc $29 203%
Nova $29 203%
Health Choices $83 582%
Medical Associates $83 582%
Preferred Health Choice $85 596%
The Alliance $178 1247%
1199 National Benefit Fund $257 1801%
Allied Benefit Systems $257 1801%
Asr Health Benefits $257 1801%
Christian Brother Services $257 1801%
Coventry $257 1801%
First Health $257 1801%
Lucent Health $257 1801%
Luminare Health $257 1801%
Medical Mutual $257 1801%
Meritain $257 1801%
Trustmark Small Business Benefits $257 1801%
Webtpa $257 1801%
Health Partners $258 1808%
Auxiant $265 1857%
Cigna $265 1857%
Medica $265 1857%
Midlands $265 1857%
Midlands Choice $265 1857%
Multiplan $265 1857%
Qualcare $265 1857%
Usa Managed Care $279 1955%
Crime Victim Assistance $294 2060%
Iowa Dept Of Public Health $294 2060%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1410 North 4Th Street, Clinton, IA 52732
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals