CMS Price Transparency Data

Hepatitis C antibody test

Facility: Fairview Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $86
Cash Discount Price: $128
vs. Medicare Baseline: 6.03x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Fairview Hospital is $86. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $128. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 6.03x the Medicare baseline. Located in 29 Lewis Avenue, Great Barrington, MA.

Cash / Self-Pay

$128

Average discount available for prompt cash payment at this facility.

Insurance Median

$86

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: $128 (897%)

Insurance Median: $86 (603%)

Cash: $128 (897% of Medicare)

Ins. Median: $86 (603% 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 603% of the Medicare baseline (a markup of 503%). 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
Capital District Physicians' Health Plan	$10 - $121	70%
Medicaid / KanCare	$10 - $13	70%
Aetna	$11 - $102	77%
Bmchnp	$13 - $14	91%
Health New England	$13 - $94	91%
Hospice	$14 - $53	98%
Medicare (plans)	$14 - $51	98%
Other Government	$14 - $53	98%
Point32Health	$14 - $128	98%
UnitedHealthcare	$14 - $116	98%
Fallon	$15 - $59	105%
Blue Cross Blue Shield	$16 - $114	112%
Commcare Alliance	$17 - $51	119%
Comm Fallon Qhp	$21 - $83	147%
Unicare	$30 - $87	210%
Workers Comp	$86	603%
Allways Nhp	$87	610%
Comm Hne Hmo	$89 - $101	624%
Comm Hne Ppo	$94 - $101	659%
Cigna	$121 - $125	848%
Mvp	$121	848%
Oxford	$121	848%
First Health	$125 - $128	876%
Connecticare	$128	897%
Consolidated Health Plans	$128	897%
Other Commercial	$128	897%
Phcs	$128	897%
Self Pay	$128	897%

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 $128.
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 Fairview 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.