CMS Price Transparency Data

Hepatitis C antibody test

Facility: Kossuth Regional Health Center

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $123
Cash Discount Price: $122
vs. Medicare Baseline: 8.62x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Kossuth Regional Health Center is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $122. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 8.62x the Medicare baseline. Located in 1515 South Phillips Street, Algona, IA.

Cash / Self-Pay

$122

Average discount available for prompt cash payment at this facility.

Insurance Median

$123

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: $122 (855%)

Insurance Median: $123 (862%)

Cash: $122 (855% of Medicare)

Ins. Median: $123 (862% 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 862% of the Medicare baseline (a markup of 762%). 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
Blue Cross Blue Shield	$12 - $13	84%
Mercy One - All Plans	$57 - $59	399%
Va Ccn - All Plans	$57 - $59	399%
Humana	$58 - $59	406%
Amerigroup Mcr Adv - All Other Plans	$59 - $60	413%
UnitedHealthcare	$59 - $117	413%
Health Partners New Bus - All Other Plans	$106 - $108	743%
Midlands Choice - All Plans	$106 - $108	743%
Medical Associates - All Plans	$128 - $131	897%
Preferred Health - All Plans	$128 - $131	897%
Aetna	$140 - $149	981%
Multiplan - All Plans	$143 - $146	1002%
Health Partners Exisiting Bus	$146 - $149	1023%
Molina Mcaid/Chip - All Plans	$155 - $158	1086%
Amerigroup Mcaid	$157 - $160	1100%

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 $122.
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 Kossuth Regional Health 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.