CMS Price Transparency Data

Hepatitis C antibody test

Facility: HSHS St Elizabeth's Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $157
  • Cash Discount Price: $125
  • vs. Medicare Baseline: 11.00x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at HSHS St Elizabeth's Hospital is $157. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $125. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 11.00x the Medicare baseline. Located in One St Elizabeth Boulevard, O Fallon, IL.
Cash / Self-Pay
$125

Average discount available for prompt cash payment at this facility.

Insurance Median
$157

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: $125 (876%)
Insurance Median: $157 (1100%)
Cash: $125 (876% of Medicare)
Ins. Median: $157 (1100% 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 1100% of the Medicare baseline (a markup of 1000%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Molina Healthcare $8 - $174 56%
Meridian Health Plan $9 63%
Aetna $14 - $174 98%
Blue Cross Blue Shield $14 - $174 98%
Clear Spring Health Of Illinois $14 - $174 98%
Health Alliance Medical Plans $14 - $174 98%
Health Partners $14 - $174 98%
Humana $14 - $174 98%
Sae Hospice $14 - $174 98%
UnitedHealthcare $14 - $174 98%
Celtic Insurance Company $31 - $174 217%
Naphcare $32 - $174 224%
Claim Doc $36 - $174 252%
Hopetrust $36 - $174 252%
Amish Community $49 343%
Wellfirst $112 785%
First Health $129 904%
Cigna $137 - $174 960%
Healthlink $138 - $174 967%
Caterpillar, Inc. $140 981%
Consociate Group $153 1072%
Choicecare $157 1100%
Healthcare Finest Network (Hfn) $157 1100%
Multiplan/Phcs $157 1100%
Provider Network Of America $157 1100%
City Of Springfield $174 1219%
Current Health Solutions $174 1219%
Healthscope $174 1219%
Illinois Breast And Cervical Cancer Program $174 1219%
Interplan $174 1219%
Live360 $174 1219%
Wexford $174 1219%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: One St Elizabeth Boulevard, O Fallon, IL 62269
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals