CMS Price Transparency Data

Hepatitis C antibody test

Facility: Southcoast Hospitals Group

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $17
Cash Discount Price: $51
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Southcoast Hospitals Group is $17. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $51. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 1.19x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$51

Average discount available for prompt cash payment at this facility.

Insurance Median

$17

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: $51 (357%)

Insurance Median: $17 (119%)

Cash: $51 (357% of Medicare)

Ins. Median: $17 (119% 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.

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
Tufts Health Public Plans [1010213]	$12	84%
Aetna	$14 - $77	98%
Blue Cross Blue Shield	$14 - $29	98%
Evercare [1010304]	$14	98%
Medicare (plans)	$14 - $25	98%
Tufts Senior Care Options [1010315]	$14	98%
UnitedHealthcare	$14 - $17	98%
Wellsense Health Plan Senior Care Options [1020208	$14	98%
Commonwealth Care Alliance [1080501]	$15	105%
Eternal Health [1010322]	$16	112%
Fallon [1000114]	$20	140%
Wellsense Health Plan Clarity Connectorcare & Meta	$22	154%
Cigna	$32	224%
Harvard Pilgrim [1010602]	$33	231%
Wellpoint [1000102]	$36	252%
Tufts [1010701]	$42	294%
Mass General Brigham Health Plan Commercial [10122	$57	399%
Mass General Brigham Health Plan Connectorcare [10	$57	399%
Group Insurance Service Center [1013001]	$61	427%
Innovative Health Plan [1025001]	$61	427%
Priority Health [1015001]	$61	427%
PHCS [1000125]	$66	463%
First Health [1000130]	$77	540%

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 $51.
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 Southcoast Hospitals Group 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.