CMS Price Transparency Data

Hepatitis C antibody test

Facility: Madison County Health Care System

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $69
  • Cash Discount Price: $85
  • vs. Medicare Baseline: 4.84x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at Madison County Health Care System is $69. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $85. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 4.84x the Medicare baseline. Located in 300 West Hutchings Street, Winterset, IA.
Cash / Self-Pay
$85

Average discount available for prompt cash payment at this facility.

Insurance Median
$69

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: $85 (596%)
Insurance Median: $69 (484%)
Cash: $85 (596% of Medicare)
Ins. Median: $69 (484% 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 484% of the Medicare baseline (a markup of 384%). 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 $46 - $69 322%
Medical Associates Hp - All Plans $46 322%
Medigold-All Plans $46 322%
Tricare $46 322%
UnitedHealthcare $46 - $95 322%
Blue Cross Blue Shield $47 - $52 329%
American Hp Mcr Adv-All Plans $48 336%
Iowa Total Care Mcaid-All Plans $50 350%
Molina Mcaid/Chip -All Plans $52 364%
Amerigroup Mcaid-All Plans $53 371%
Madison County Sheriff-All Plans $53 371%
Oscar - All Plans $68 477%
Corvel Wc-All Plans $95 666%
Choicecare-All Plans $101 708%
First Choice-All Plans $101 708%
First Health-All Plans $101 708%
Integrated Hp-All Plans $101 708%
Mutual Of Omaha-All Plans $101 708%
Plaines Health-All Plans $101 708%
Preferred Hlth Ntwork-All Plans $101 708%
Principal Healthcare-All Plans $101 708%
Usa Managed Care-All Plans $101 708%
Medimore Employee Hp - All Plans $104 729%
Midlands Choice - All Plans $104 729%
Benefit Admin Of America-All Plans $106 743%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 300 West Hutchings Street, Winterset, IA 50273
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - Local
  • Hospital Type: Critical Access Hospitals