CMS Price Transparency Data

Hepatitis C antibody test

Facility: Memorial Medical Center

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $241
Cash Discount Price: $401
vs. Medicare Baseline: 16.89x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Memorial Medical Center is $241. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $401. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 16.89x the Medicare baseline. Located in 701 N First St, Springfield, IL.

Cash / Self-Pay

$401

Average discount available for prompt cash payment at this facility.

Insurance Median

$241

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: $401 (2810%)

Insurance Median: $241 (1689%)

Cash: $401 (2810% of Medicare)

Ins. Median: $241 (1689% 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 1689% of the Medicare baseline (a markup of 1589%). 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
Health Alliance	$6 - $261	42%
Veterans Administration	$10	70%
Medicaid / KanCare	$12	84%
Molina	$12	84%
Blue Cross Blue Shield	$13 - $401	91%
Aetna	$14 - $305	98%
Medicare (plans)	$14 - $401	98%
Tricare	$14	98%
UnitedHealthcare	$14 - $249	98%
Humana	$15 - $241	105%
Healthlink	$50 - $253	350%
Commercial Workers Compensation	$87	610%
Illinois Workers Compensation	$92	645%
Current Health Network Ppo	$180	1261%
Cigna	$211	1479%
Phcs/Multiplan	$217 - $241	1521%
6 Degrees Health	$241	1689%
Hopetrust	$241	1689%
Hst	$241	1689%
Magellan	$241	1689%
Consociate	$261	1829%
Hfn	$261	1829%
Preferred Plan	$301	2109%
Soi Mcfarland	$301	2109%
Soi Rushville	$301	2109%
Corvel	$321	2249%
Methodist First Choice	$321	2249%
Mutual Medical Plans	$341	2390%
Liability	$401	2810%

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 $401.
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 Memorial Medical 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.