CMS Price Transparency Data

Hepatitis C antibody test

Facility: Down East Community Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $239
  • Cash Discount Price: $216
  • vs. Medicare Baseline: 16.75x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at Down East Community Hospital is $239. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $216. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 16.75x the Medicare baseline. Located in 11 Hospital Drive, Machias, ME.
Cash / Self-Pay
$216

Average discount available for prompt cash payment at this facility.

Insurance Median
$239

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: $216 (1514%)
Insurance Median: $239 (1675%)
Cash: $216 (1514% of Medicare)
Ins. Median: $239 (1675% 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 1675% of the Medicare baseline (a markup of 1575%). 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
Blue Cross Blue Shield $127 - $232 890%
Humana $127 890%
Wellcare $127 890%
Partners Direct Health $144 1009%
Community Health Options $238 1668%
Aetna $240 1682%
UnitedHealthcare $248 1738%
Martins Point $259 1815%
Patients Advocates $259 1815%
Cigna $260 1822%
Harvard Pilgrim $264 1850%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 11 Hospital Drive, Machias, ME 04654
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals