CMS Price Transparency Data

Hepatitis C antibody test

Facility: Sanford Westbrook Medical Center

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $232
  • Cash Discount Price: $222
  • vs. Medicare Baseline: 16.26x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at Sanford Westbrook Medical Center is $232. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $222. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 16.26x the Medicare baseline. Located in 920 Bell Avenue Po Box 188, Westbrook, MN.
Cash / Self-Pay
$222

Average discount available for prompt cash payment at this facility.

Insurance Median
$232

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: $222 (1556%)
Insurance Median: $232 (1626%)
Cash: $222 (1556% of Medicare)
Ins. Median: $232 (1626% 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 1626% of the Medicare baseline (a markup of 1526%). 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 $67 - $257 470%
Sanford Health Plan Align $119 834%
Ucare $128 - $244 897%
Wellmark Sd $128 897%
Aetna $129 - $242 904%
Health Partners $129 - $222 904%
Medicare (plans) $129 904%
UnitedHealthcare $129 - $232 904%
Primewest $131 - $141 918%
Security Health Plan $153 1072%
Sanford Health Plan $219 - $258 1535%
Medica $244 - $263 1710%
Cigna $250 1752%
First Choice Health Network $250 1752%
Healthez $250 1752%
Multiplan $250 1752%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 920 Bell Avenue Po Box 188, Westbrook, MN 56183
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals