CMS Price Transparency Data

Hepatitis C antibody test

Facility: Nell J Redfield Memorial Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $76
Cash Discount Price: $102
vs. Medicare Baseline: 5.33x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Nell J Redfield Memorial Hospital is $76. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $102. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 5.33x the Medicare baseline. Located in 150 North 200 West, Malad City, ID.

Cash / Self-Pay

$102

Average discount available for prompt cash payment at this facility.

Insurance Median

$76

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: $102 (715%)

Insurance Median: $76 (533%)

Cash: $102 (715% of Medicare)

Ins. Median: $76 (533% 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 533% of the Medicare baseline (a markup of 433%). 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
Regence Bs Comm - All Other Plans	$13 - $21	91%
UnitedHealthcare	$13 - $128	91%
Bc Mcr Adv	$45 - $76	315%
Choicecare Mcr Adv	$45 - $76	315%
Regence Bs Mcr	$45 - $75	315%
Aetna	$46 - $123	322%
Pacificsource Mcr Adv - All Plans	$46 - $77	322%
University Of Ut - All Plans	$72 - $120	505%
Bc Comm - All Other Plans	$76	533%
Choicecare Ppo - All Other Plans	$76 - $128	533%
Town & Country - All Plans	$76 - $128	533%
Brightpath Select Hlth - All Plans	$81 - $135	568%

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 $102.
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 Nell J Redfield Memorial 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.