CMS Price Transparency Data

Hepatitis C antibody test

Facility: Mercyone Elkader Medical Center

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $144
Cash Discount Price: $127
vs. Medicare Baseline: 10.09x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Mercyone Elkader Medical Center is $144. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $127. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 10.09x the Medicare baseline. Located in 901 Davidson Street Nw, Elkader, IA.

Cash / Self-Pay

$127

Average discount available for prompt cash payment at this facility.

Insurance Median

$144

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: $127 (890%)

Insurance Median: $144 (1009%)

Cash: $127 (890% of Medicare)

Ins. Median: $144 (1009% 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 1009% of the Medicare baseline (a markup of 909%). 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
Aetna	$14 - $144	98%
Blue Cross Blue Shield	$14	98%
Medicare (plans)	$14 - $103	98%
UnitedHealthcare	$15 - $146	105%
Amish Hospital Aid	$19	133%
Centivo	$21	147%
Ambetter / Centene	$24	168%
Claimdoc	$29	203%
Nova	$29	203%
Iowa Total Care	$121	848%
Medicaid / KanCare	$123 - $124	862%
1199 National Benefit Fund	$144	1009%
Allied Benefit Systems	$144	1009%
Asr Health Benefits	$144	1009%
Christian Brother Services	$144	1009%
Coventry	$144	1009%
First Health	$144	1009%
Lucent Health	$144	1009%
Luminare Health	$144	1009%
Medical Mutual	$144	1009%
Meritain	$144	1009%
Trustmark Small Business Benefits	$144	1009%
Webtpa	$144	1009%
Geha	$146	1023%
Health Choices	$156	1093%
Medical Associates	$156	1093%
Health Partners	$188	1317%
Auxiant	$191	1338%
Cigna	$191	1338%
Medica	$191	1338%
Midlands	$191	1338%
Midlands Choice	$191	1338%
Crime Victim Assistance	$195	1367%
Iowa Dept Of Public Health	$195	1367%

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 $127.
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 Mercyone Elkader 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.