CMS Price Transparency Data

Hepatitis C antibody test

Facility: Monroe County Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $82
Cash Discount Price: $103
vs. Medicare Baseline: 5.75x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Monroe County Hospital is $82. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $103. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 5.75x the Medicare baseline. Located in 6580 165Th Street, Albia, IA.

Cash / Self-Pay

$103

Average discount available for prompt cash payment at this facility.

Insurance Median

$82

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: $103 (722%)

Insurance Median: $82 (575%)

Cash: $103 (722% of Medicare)

Ins. Median: $82 (575% 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 575% of the Medicare baseline (a markup of 475%). 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
Va Ccn - All Plans	$12 - $36	84%
Wellmark Hmo	$13	91%
Wellmark Ppo - All Other Plans	$14	98%
Aetna	$37 - $240	259%
Amerigroup Mcare	$37 - $108	259%
Humana	$37 - $108	259%
Mahp Mcare - All Plans	$37 - $107	259%
Tricare	$37 - $107	259%
UnitedHealthcare	$37 - $242	259%
Wellmark Mcare	$37 - $108	259%
Iowa Total Care Mcaid - All Plans	$43 - $127	301%
Molina Mcaid - All Plans	$44 - $129	308%
Amerigroup Mcaid - All Other Plans	$45 - $131	315%
Centivo - All Plans	$55 - $161	385%
Midlands Choice - All Plans	$61 - $178	427%
Preferred Hlth - All Plans	$65 - $191	456%
Geha - All Plans	$70 - $204	491%
Multiplan - All Plans	$78 - $230	547%
Integrated Hp - All Plans	$84 - $247	589%

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 $103.
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 Monroe County Hospital 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.