CMS Price Transparency Data

Hepatitis C antibody test

Facility: Perham Health

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $35
Cash Discount Price: $63
vs. Medicare Baseline: 2.45x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Perham Health is $35. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 2.45x the Medicare baseline. Located in 1000 Coney Street West, Perham, MN.

Cash / Self-Pay

$63

Average discount available for prompt cash payment at this facility.

Insurance Median

$35

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: $63 (441%)

Insurance Median: $35 (245%)

Cash: $63 (441% of Medicare)

Ins. Median: $35 (245% 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 245% of the Medicare baseline (a markup of 145%). 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
Blue Cross Blue Shield	$27 - $66	189%
Health Partners Mcr Adv	$33	231%
Humana	$33	231%
Medica Mcr Adv	$33	231%
Medicare (plans)	$33 - $37	231%
Ucare Mn Senior Health Options	$33	231%
UnitedHealthcare	$34 - $76	238%
Medicaid / KanCare	$35	245%
Ucare Mn Medical Assistance	$35	245%
Ucare Mn Minnesota Care	$35	245%
Ucare Mn Senior Care Plus	$35	245%
Ucare Mn Special Needs Basic Care	$35	245%
Ucare Mn Special Needs Basic Care Dual	$35	245%
Medica Mcaid Mn Care	$36	252%
Medica Mn (Msho)	$40	280%
Ucare Individual And Family Plan-All Other Plans	$40 - $41	280%
Medica Mn Senior Hp/Outside Mn	$44 - $45	308%
Health Partners Minnesota Care	$48 - $49	336%
Medica Commercial-All Other Plans	$71 - $72	498%
Preferred One (Pchp, Pic, Pas)-All Other Plans	$73 - $74	512%
Health Partners-All Plans	$80	561%
Preferred One (Ppo)	$82 - $83	575%
Sanford Health Plan-All Plans	$82 - $83	575%

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 $63.
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 Perham Health 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.