CMS Price Transparency Data
Hepatitis C antibody test
Facility: Trinity Health Oakland Hospital
Billing Code: 86803 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 86803
- Insurance Median: $51
- Cash Discount Price: $49
- vs. Medicare Baseline: 3.57x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at Trinity Health Oakland Hospital is $51. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $49. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 3.57x the Medicare baseline. Located in 44405 Woodward Ave, Pontiac, MI.
Cash / Self-Pay
$49
Average discount available for prompt cash payment at this facility.
Insurance Median
$51
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: $49 (343%)
Insurance Median: $51 (357%)
Cash: $49 (343% of Medicare)
Ins. Median: $51 (357% 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 357% of the Medicare baseline (a markup of 257%). 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 | $8 - $15 | 56% |
| Medicaid / KanCare | $8 | 56% |
| Aetna | $14 - $38 | 98% |
| Align Senior Care | $14 | 98% |
| Blue Care Network Advantage | $14 | 98% |
| Hospice Advantage | $14 | 98% |
| Medicare (plans) | $14 | 98% |
| Bcn Domestic | $15 | 105% |
| Blue Benefit Administrators Of Massachusetts | $15 | 105% |
| Blue Care Network | $15 | 105% |
| Blue Distinction Transplant | $15 | 105% |
| Blue Shield - Ca | $15 | 105% |
| Blue Shield - Id (Regence) | $15 | 105% |
| Blue Shield - Ny Highmark Northeastern | $15 | 105% |
| Blue Shield - Ny Highmark Western | $15 | 105% |
| Blue Shield - Pa (Highmark) | $15 | 105% |
| Blue Shield - Wa (Regence) | $15 | 105% |
| Cca - Zing Health | $15 | 105% |
| Health Choices | $15 - $61 | 105% |
| Kaiser Domestic | $15 | 105% |
| UnitedHealthcare | $15 - $62 | 105% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $16 | 112% |
| U Of M Health Plan | $17 | 119% |
| Molina Marketplace | $19 | 133% |
| Priority Health | $20 - $22 | 140% |
| Geha | $21 - $62 | 147% |
| Medical Mutual | $21 | 147% |
| Meritain | $21 | 147% |
| Wc Accident Fund | $21 - $25 | 147% |
| Wc Advantage | $21 - $25 | 147% |
| Wc Aig | $21 - $25 | 147% |
| Wc Allied | $21 - $25 | 147% |
| Wc Amerisure | $21 - $25 | 147% |
| Wc Amtrust | $21 - $25 | 147% |
| Wc Asu Risk Mgt | $21 - $25 | 147% |
| Wc Berkley Admin | $21 - $25 | 147% |
| Wc Broadspire | $21 - $25 | 147% |
| Wc Bunch & Associates | $21 - $25 | 147% |
| Wc Ccmsi | $21 - $25 | 147% |
| Wc Emc Insurance Company | $21 - $25 | 147% |
| Wc Esis | $21 - $25 | 147% |
| Wc Fcci | $21 - $25 | 147% |
| Wc Federated | $21 - $25 | 147% |
| Wc Gallagher Bassett | $21 - $25 | 147% |
| Wc Genex Care For Ohio | $21 - $25 | 147% |
| Wc Guard Insurance Company | $21 - $25 | 147% |
| Wc Hartford | $21 - $25 | 147% |
| Wc Liberty Mutual | $21 - $25 | 147% |
| Wc Meijers | $21 - $25 | 147% |
| Wc Michigan | $21 - $25 | 147% |
| Wc Mitchell Frankenmuth | $21 - $25 | 147% |
| Wc Pma | $21 - $25 | 147% |
| Wc Sedgwick | $21 - $25 | 147% |
| Wc Sentry | $21 - $25 | 147% |
| Wc Travelers | $21 - $25 | 147% |
| Wc Tristar | $21 - $25 | 147% |
| Wc Walmart | $21 - $25 | 147% |
| Wc Zurich | $21 - $25 | 147% |
| Health Cost Solutions | $22 | 154% |
| Vitalcore | $22 | 154% |
| Wellpath | $22 | 154% |
| Acs Benefit Services | $30 - $37 | 210% |
| Allied Benefit Systems | $30 - $37 | 210% |
| Claimchoice Adminstrators | $30 - $37 | 210% |
| Consociate | $30 - $37 | 210% |
| Cypress Benefit Administrators | $30 - $37 | 210% |
| Forest County Potawatomi | $30 - $37 | 210% |
| Health Smart | $30 - $37 | 210% |
| Healthgram | $30 - $37 | 210% |
| Healthscope | $30 - $37 | 210% |
| Secureone Preferred United Plans | $30 - $37 | 210% |
| Sisco Benefits | $30 - $37 | 210% |
| The Health Plan | $30 - $37 | 210% |
| Trustmark Small Business Benefits | $30 - $37 | 210% |
| Unified Group Services | $30 - $37 | 210% |
| Webtpa | $30 - $37 | 210% |
| Employee Benefit Logistic | $32 | 224% |
| Mclaren Health | $33 - $44 | 231% |
| Carelon Behavioral Health | $34 - $42 | 238% |
| Magellan Behavioral Health | $41 - $50 | 287% |
| Asr Health Benefits | $43 | 301% |
| Caresource | $43 | 301% |
| Hap | $43 - $60 | 301% |
| Varipro | $43 | 301% |
| 1199 National Benefit Fund | $47 - $56 | 329% |
| Allied National Global Care | $47 - $56 | 329% |
| Asrm - Reliance Standard Life Insurance | $47 - $56 | 329% |
| Christian Care Ministry | $47 - $56 | 329% |
| Dean Health | $47 - $56 | 329% |
| Fallon Health | $47 - $56 | 329% |
| Family Life Insurance Company | $47 - $56 | 329% |
| Ghc Scw | $47 - $56 | 329% |
| Group Pension Administrators | $47 - $56 | 329% |
| International Benefit Administrators | $47 - $56 | 329% |
| Lifetime Benefit Solutions | $47 - $56 | 329% |
| Manhattan Life | $47 - $56 | 329% |
| Medi Share | $47 - $56 | 329% |
| Multiplan | $47 - $56 | 329% |
| Mvp | $47 - $56 | 329% |
| Pai | $47 - $56 | 329% |
| Pan-American Life | $47 - $56 | 329% |
| Paramount Hmo | $47 - $56 | 329% |
| Phcs | $47 - $56 | 329% |
| Trinity Health Share | $47 - $56 | 329% |
| Health Partners | $50 - $60 | 350% |
| Tufts Health Plan | $50 - $60 | 350% |
| Access Health | $51 - $61 | 357% |
| Acclaim | $51 - $61 | 357% |
| Administrative Concepts | $51 - $61 | 357% |
| Allegeant | $51 - $61 | 357% |
| Ameriben | $51 - $61 | 357% |
| American Family | $51 - $61 | 357% |
| American Healthcare Alliance | $51 - $61 | 357% |
| American National | $51 - $61 | 357% |
| American Republic | $51 - $61 | 357% |
| Amerihealth | $51 - $61 | 357% |
| Aultcare | $51 - $61 | 357% |
| Automated Benefit Services | $51 - $61 | 357% |
| Auxiant | $51 - $61 | 357% |
| Benefit Administrative Systems,Llc | $51 - $61 | 357% |
| Boon Chapman | $51 - $61 | 357% |
| Cam Administrative Services | $51 - $61 | 357% |
| Christian Brother Services | $51 - $61 | 357% |
| Christian Brothers Holy Cross | $51 - $61 | 357% |
| Cigna | $51 - $62 | 357% |
| Comprehensive Benefits | $51 - $61 | 357% |
| Continental Life Insurance | $51 - $61 | 357% |
| Custom Benefit Administrators | $51 - $61 | 357% |
| Employee Benefit Concepts | $51 - $61 | 357% |
| Employee Benefit Management | $51 - $61 | 357% |
| Enterprise Group Planning | $51 - $61 | 357% |
| Freedom Life Insurance Company | $51 - $61 | 357% |
| Group Administrators | $51 - $61 | 357% |
| Group Marketing Services | $51 - $61 | 357% |
| Guardian | $51 - $61 | 357% |
| Health America | $51 - $61 | 357% |
| Healthcare Management Admin | $51 - $61 | 357% |
| Healthez | $51 - $61 | 357% |
| Humana | $51 - $61 | 357% |
| Insight | $51 - $61 | 357% |
| Intercare | $51 - $61 | 357% |
| Jfp Benefit Management | $51 - $61 | 357% |
| Jp Farley Corporation | $51 - $61 | 357% |
| Key Benefit Administrator | $51 - $61 | 357% |
| Liberty Union Life Assurance Co | $51 - $61 | 357% |
| Lucent Health | $51 - $61 | 357% |
| Luminare Health | $51 - $61 | 357% |
| Luminare Health (Detroit) | $51 - $61 | 357% |
| Magnacare | $51 - $61 | 357% |
| Medben | $51 - $61 | 357% |
| Medcost | $51 - $61 | 357% |
| Mutual Health Services | $51 - $61 | 357% |
| Mutual Of Omaha | $51 - $61 | 357% |
| Ncas | $51 - $61 | 357% |
| Nippon Life Ins | $51 - $61 | 357% |
| Nova | $51 - $61 | 357% |
| Painters Union Insurance Fund | $51 - $61 | 357% |
| Physicians Mutual | $51 - $61 | 357% |
| Plumbers Local 98 Insurance Fund | $51 - $61 | 357% |
| Prairie States | $51 - $61 | 357% |
| Preferred One | $51 - $61 | 357% |
| Primary Physician Care | $51 - $61 | 357% |
| Professional Benefit Administrators | $51 - $61 | 357% |
| Siho Insurance Services | $51 - $61 | 357% |
| The Loomis Company | $51 - $61 | 357% |
| Unicare | $51 - $61 | 357% |
| Us Health And Life | $51 - $61 | 357% |
| Valenz | $51 - $61 | 357% |
| Western & Southern Financial Group | $51 - $61 | 357% |
| Wps | $51 - $61 | 357% |
| Coventry | $52 - $63 | 364% |
| First Health | $52 - $63 | 364% |
| Prime Health Services | $55 - $66 | 385% |
| Three Rivers Provider Network | $62 - $75 | 434% |
| Cmh Detroit Wayne Integrated Health Network | $69 - $83 | 484% |
| Cmh Lenawee County | $69 - $83 | 484% |
| Cmh Livingston County | $69 - $83 | 484% |
| Cmh Misc | $69 - $83 | 484% |
| Cmh Monroe County | $69 - $83 | 484% |
| Cmh Oakland County | $69 - $83 | 484% |
| Cmh Washtenaw County | $69 - $83 | 484% |