CMS Price Transparency Data

Hepatitis C antibody test

Facility: Saint Joseph Regional Medical Center

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $56
  • Cash Discount Price: $138
  • vs. Medicare Baseline: 3.92x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at Saint Joseph Regional Medical Center is $56. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $138. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 3.92x the Medicare baseline. Located in 5215 Holy Cross Pkwy, Mishawaka, IN.
Cash / Self-Pay
$138

Average discount available for prompt cash payment at this facility.

Insurance Median
$56

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: $138 (967%)
Insurance Median: $56 (392%)
Cash: $138 (967% of Medicare)
Ins. Median: $56 (392% 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 392% of the Medicare baseline (a markup of 292%). 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
Aetna $8 - $103 56%
Blue Cross Blue Shield $8 - $29 56%
Medicaid / KanCare $8 - $14 56%
UnitedHealthcare $8 - $135 56%
Managed Health Services - Indiana $14 98%
Mdwise $14 98%
Medicare (plans) $14 - $15 98%
Meridian Complete $14 98%
Pace-Trinity Health $14 98%
County Coroner $15 105%
Provider Partners Health Plan Of Indiana $16 112%
Auxiant $21 - $176 147%
Physicians Health Plan Northern Indiana Health Insurance $21 - $43 147%
St Joseph County Hlth Dpt $21 147%
Caresource $22 154%
Siho Insurance Services $23 161%
Key Benefit Administrator $26 - $132 182%
Allied Benefit Systems $27 - $138 189%
Blue Benefit Administrators Of Massachusetts $29 203%
Blue Care Network $29 203%
Blue Distinction Transplant $29 203%
Blue Shield - Ca $29 203%
Blue Shield - Id (Regence) $29 203%
Blue Shield - Ny Highmark Northeastern $29 203%
Blue Shield - Ny Highmark Western $29 203%
Blue Shield - Pa (Highmark) $29 203%
Blue Shield - Wa (Regence) $29 203%
Custom Design Benefits $31 217%
Hospice Of Marshall County $55 385%
Hospice Of St Joseph County $55 385%
Plain Church Group $57 399%
Asr Health Benefits $103 722%
Christian Brother Services $103 722%
Employee Benefit Management $103 722%
Medical Mutual $103 722%
Meritain $103 722%
Preferred One $103 722%
Rural Carrier Health Benefit Plan $103 722%
Webtpa $103 722%
Notre Dame Athletic Association $117 820%
Wc Notre Dame $117 820%
Luminare Health (Detroit) $121 - $127 848%
Encore Health $126 - $132 883%
Ameriben $127 890%
Indiana Criminal Justice Inst $132 925%
Western & Southern Financial Group $132 925%
Geha $135 946%
Healthscope $135 946%
Student Insurance Cma $135 946%
Cigna $136 953%
Group Administrators $136 953%
Health Partners $136 953%
Mvp $136 953%
Prairie States $136 953%
Priority Health $136 953%
Professional Benefit Administrators $136 953%
Sagamore Health Network $136 - $157 953%
Sisco Benefits $136 953%
Unified Group Services $136 953%
Goshen Preferred Network $163 - $182 1142%
Christian Brothers Holy Cross $170 1191%
Signature Care $170 1191%
Bankers Life Casualty $212 1486%
Bureau Of Disability $212 1486%
Wc Align Network $212 1486%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 5215 Holy Cross Pkwy, Mishawaka, IN 46545
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals