CMS Price Transparency Data

Hepatitis C antibody test

Facility: Kootenai Health

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $65
Cash Discount Price: $65
vs. Medicare Baseline: 4.56x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Kootenai Health is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $65. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 4.56x the Medicare baseline. Located in 2003 Kootenai Health Way, Coeur D'Alene, ID.

Cash / Self-Pay

$65

Average discount available for prompt cash payment at this facility.

Insurance Median

$65

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: $65 (456%)

Insurance Median: $65 (456%)

Cash: $65 (456% of Medicare)

Ins. Median: $65 (456% 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 456% of the Medicare baseline (a markup of 356%). 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
UnitedHealthcare	$8 - $119	56%
Magellan	$12 - $16	84%
Wellpoint	$12 - $16	84%
Coordinated Care Of Washington	$13	91%
Molina Healthcare Of Idaho	$13 - $49	91%
Molina Healthcare Of Washington	$13	91%
Blue Cross Blue Shield	$14 - $119	98%
Humana	$14	98%
Pacificsource	$14 - $31	98%
Premera	$14 - $82	98%
Regence Blue Shield Of Idaho	$14	98%
Aetna	$15 - $110	105%
Group Health/Kaiser	$51	357%
Mountain Health Co-Op	$60 - $102	420%
Cigna	$63 - $110	441%
Interwest Health	$65 - $112	456%
First Choice Health (Ameriben)	$66 - $114	463%

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 $65.
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 Kootenai Health 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.