CMS Price Transparency Data
Hepatitis C antibody test
Facility: Trinity Health Muskegon Hospital
Billing Code: 86803 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 86803
- Insurance Median: $57
- Cash Discount Price: $50
- vs. Medicare Baseline: 3.99x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at Trinity Health Muskegon Hospital is $57. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $50. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 3.99x the Medicare baseline. Located in 1500 E Sherman Blvd, Muskegon, MI.
Cash / Self-Pay
$50
Average discount available for prompt cash payment at this facility.
Insurance Median
$57
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: $50 (350%)
Insurance Median: $57 (399%)
Cash: $50 (350% of Medicare)
Ins. Median: $57 (399% 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 399% of the Medicare baseline (a markup of 299%). 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 - $18 | 56% |
| Medicaid / KanCare | $8 | 56% |
| Access Health | $10 | 70% |
| Aetna | $14 - $35 | 98% |
| Align Senior Care | $14 | 98% |
| Blue Care Network Advantage | $14 | 98% |
| Correctional Recovery | $14 | 98% |
| Heartland Hospice | $14 | 98% |
| Hospice Harbor Hospice | $14 | 98% |
| Medicare (plans) | $14 | 98% |
| Oscar | $14 | 98% |
| UnitedHealthcare | $15 - $72 | 105% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $16 | 112% |
| U Of M Health Plan | $17 - $65 | 119% |
| Bcn Domestic | $18 | 126% |
| Blue Benefit Administrators Of Massachusetts | $18 | 126% |
| Blue Care Network | $18 | 126% |
| Blue Distinction Transplant | $18 | 126% |
| Blue Shield - Ca | $18 | 126% |
| Blue Shield - Id (Regence) | $18 | 126% |
| Blue Shield - Ny Highmark Northeastern | $18 | 126% |
| Blue Shield - Ny Highmark Western | $18 | 126% |
| Blue Shield - Pa (Highmark) | $18 | 126% |
| Blue Shield - Wa (Regence) | $18 | 126% |
| Health Choices | $18 - $65 | 126% |
| Kaiser Domestic | $18 | 126% |
| Molina Marketplace | $19 | 133% |
| Geha | $21 - $72 | 147% |
| Meritain | $21 | 147% |
| Vitalcore | $22 | 154% |
| Wellpath | $22 | 154% |
| Acs Benefit Services | $37 - $43 | 259% |
| Allied Benefit Systems | $37 - $43 | 259% |
| Claimchoice Adminstrators | $37 - $43 | 259% |
| Consociate | $37 - $43 | 259% |
| Cypress Benefit Administrators | $37 - $43 | 259% |
| Forest County Potawatomi | $37 - $43 | 259% |
| Health Smart | $37 - $43 | 259% |
| Healthgram | $37 - $43 | 259% |
| Healthscope | $37 - $43 | 259% |
| Preferred One | $37 - $43 | 259% |
| Secureone Preferred United Plans | $37 - $43 | 259% |
| Sisco Benefits | $37 - $43 | 259% |
| The Health Plan | $37 - $43 | 259% |
| Trustmark Small Business Benefits | $37 - $43 | 259% |
| Unified Group Services | $37 - $43 | 259% |
| Webtpa | $37 - $43 | 259% |
| Asr Health Benefits | $38 - $44 | 266% |
| Hap | $38 - $65 | 266% |
| Wc Accident Fund | $38 - $44 | 266% |
| Wc Advantage | $38 - $44 | 266% |
| Wc Aig | $38 - $44 | 266% |
| Wc Allied | $38 - $44 | 266% |
| Wc Amerisure | $38 - $44 | 266% |
| Wc Amtrust | $38 - $44 | 266% |
| Wc Asu Risk Mgt | $38 - $44 | 266% |
| Wc Berkley Admin | $38 - $44 | 266% |
| Wc Broadspire | $38 - $44 | 266% |
| Wc Bunch & Associates | $38 - $44 | 266% |
| Wc Ccmsi | $38 - $44 | 266% |
| Wc Emc Insurance Company | $38 - $44 | 266% |
| Wc Esis | $38 - $44 | 266% |
| Wc Fcci | $38 - $44 | 266% |
| Wc Federated | $38 - $44 | 266% |
| Wc Gallagher Bassett | $38 - $44 | 266% |
| Wc Genex Care For Ohio | $38 - $44 | 266% |
| Wc Guard Insurance Company | $38 - $44 | 266% |
| Wc Hartford | $38 - $44 | 266% |
| Wc Liberty Mutual | $38 - $44 | 266% |
| Wc Meijers | $38 - $44 | 266% |
| Wc Michigan | $38 - $44 | 266% |
| Wc Mitchell Frankenmuth | $38 - $44 | 266% |
| Wc Pma | $38 - $44 | 266% |
| Wc Sedgwick | $38 - $44 | 266% |
| Wc Sentry | $38 - $44 | 266% |
| Wc Travelers | $38 - $44 | 266% |
| Wc Tristar | $38 - $44 | 266% |
| Wc Walmart | $38 - $44 | 266% |
| Wc Zurich | $38 - $44 | 266% |
| Hospice Of Michigan | $40 - $45 | 280% |
| Nomi Health | $40 - $46 | 280% |
| Varipro | $42 - $47 | 294% |
| Caresource | $45 - $52 | 315% |
| Cigna | $45 - $52 | 315% |
| 1199 National Benefit Fund | $54 - $62 | 378% |
| Allied National Global Care | $54 - $62 | 378% |
| Asrm - Reliance Standard Life Insurance | $54 - $62 | 378% |
| Christian Care Ministry | $54 - $62 | 378% |
| Dean Health | $54 - $62 | 378% |
| Fallon Health | $54 - $62 | 378% |
| Family Life Insurance Company | $54 - $62 | 378% |
| Ghc Scw | $54 - $62 | 378% |
| Group Pension Administrators | $54 - $62 | 378% |
| International Benefit Administrators | $54 - $62 | 378% |
| Lifetime Benefit Solutions | $54 - $62 | 378% |
| Manhattan Life | $54 - $62 | 378% |
| Medi Share | $54 - $62 | 378% |
| Multiplan | $54 - $62 | 378% |
| Mvp | $54 - $62 | 378% |
| Pai | $54 - $62 | 378% |
| Pan-American Life | $54 - $62 | 378% |
| Paramount Hmo | $54 - $62 | 378% |
| Phcs | $54 - $62 | 378% |
| Trinity Health Share | $54 - $62 | 378% |
| Acclaim | $57 - $65 | 399% |
| Administrative Concepts | $57 - $65 | 399% |
| Allegeant | $57 - $65 | 399% |
| Ameriben | $57 - $65 | 399% |
| American Family | $57 - $65 | 399% |
| American Healthcare Alliance | $57 - $65 | 399% |
| American Republic | $57 - $65 | 399% |
| Amerihealth | $57 - $65 | 399% |
| Aultcare | $57 - $65 | 399% |
| Automated Benefit Services | $57 - $65 | 399% |
| Auxiant | $57 - $65 | 399% |
| Benefit Administrative Systems,Llc | $57 - $65 | 399% |
| Boon Chapman | $57 - $65 | 399% |
| Cam Administrative Services | $57 - $65 | 399% |
| Christian Brother Services | $57 - $65 | 399% |
| Christian Brothers Holy Cross | $57 - $65 | 399% |
| Comprehensive Benefits | $57 - $65 | 399% |
| Continental Life Insurance | $57 - $65 | 399% |
| Custom Benefit Administrators | $57 - $65 | 399% |
| Employee Benefit Concepts | $57 - $65 | 399% |
| Employee Benefit Management | $57 - $65 | 399% |
| Enterprise Group Planning | $57 - $65 | 399% |
| Freedom Life Insurance Company | $57 - $65 | 399% |
| Group Administrators | $57 - $65 | 399% |
| Group Marketing Services | $57 - $65 | 399% |
| Guardian | $57 - $65 | 399% |
| Health America | $57 - $65 | 399% |
| Healthez | $57 - $65 | 399% |
| Humana | $57 - $65 | 399% |
| Insight | $57 - $65 | 399% |
| Intercare | $57 - $65 | 399% |
| Jfp Benefit Management | $57 - $65 | 399% |
| Jp Farley Corporation | $57 - $65 | 399% |
| Key Benefit Administrator | $57 - $65 | 399% |
| Liberty Union Life Assurance Co | $57 - $65 | 399% |
| Lucent Health | $57 - $65 | 399% |
| Luminare Health | $57 - $65 | 399% |
| Luminare Health (Detroit) | $57 - $65 | 399% |
| Medben | $57 - $65 | 399% |
| Medcost | $57 - $65 | 399% |
| Medical Mutual | $57 - $65 | 399% |
| Mutual Health Services | $57 - $65 | 399% |
| Mutual Of Omaha | $57 - $65 | 399% |
| Ncas | $57 - $65 | 399% |
| Nippon Life Ins | $57 - $65 | 399% |
| Nova | $57 - $65 | 399% |
| Painters Union Insurance Fund | $57 - $65 | 399% |
| Physicians Mutual | $57 - $65 | 399% |
| Plumbers Local 98 Insurance Fund | $57 - $65 | 399% |
| Prairie States | $57 - $65 | 399% |
| Primary Physician Care | $57 - $65 | 399% |
| Professional Benefit Administrators | $57 - $65 | 399% |
| The Loomis Company | $57 - $65 | 399% |
| Unicare | $57 - $65 | 399% |
| Us Health And Life | $57 - $65 | 399% |
| Valenz | $57 - $65 | 399% |
| Western & Southern Financial Group | $57 - $65 | 399% |
| Wps | $57 - $65 | 399% |
| First Health | $59 - $67 | 413% |
| Priority Health | $64 - $71 | 448% |
| Barinet | $72 - $82 | 505% |
| Cmh Allegan County | $72 - $82 | 505% |
| Cmh Barry County | $72 - $82 | 505% |
| Cmh Berrien County | $72 - $82 | 505% |
| Cmh Cass County | $72 - $82 | 505% |
| Cmh Kalamazoo | $72 - $82 | 505% |
| Cmh Kent County | $72 - $82 | 505% |
| Cmh Misc | $72 - $82 | 505% |
| Cmh Muskegon County | $72 - $82 | 505% |
| Cmh North Country | $72 - $82 | 505% |
| Cmh Northern Lakes County | $72 - $82 | 505% |
| Cmh Ottawa County | $72 - $82 | 505% |
| Cmh Van Buren County | $72 - $82 | 505% |
| Cmh West Mi County | $72 - $82 | 505% |