CMS Price Transparency Data

Hepatitis C antibody test

Facility: Hermann Area District Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $150
Cash Discount Price: $150
vs. Medicare Baseline: 10.51x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Hermann Area District Hospital is $150. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $150. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 10.51x the Medicare baseline. Located in 509 W 18Th St, Hermann, MO.

Cash / Self-Pay

$150

Average discount available for prompt cash payment at this facility.

Insurance Median

$150

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: $150 (1051%)

Insurance Median: $150 (1051%)

Cash: $150 (1051% of Medicare)

Ins. Median: $150 (1051% 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 1051% of the Medicare baseline (a markup of 951%). 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
UnitedHealthcare	$21 - $113	147%
Coventry - All Plans	$33 - $38	231%
Tricare	$91 - $106	638%
Cigna	$94 - $109	659%
Choicecare Mcr Adv- All Plans	$97 - $113	680%
American Hlth Mcr Adv- All Plans	$101 - $118	708%
Blue Cross Blue Shield	$101 - $218	708%
Humana	$101 - $118	708%
Aetna	$103 - $255	722%
Wellcare Mcr Adv - All Plans	$103 - $120	722%
Harmony Hp Mcaid- All Plans	$134 - $155	939%
Healthcare Usa Mcaid- All Plans	$150 - $174	1051%
Healthlink Hmo	$150 - $174	1051%
Ambetter / Centene	$162 - $189	1135%
Healthlink Ppo - All Other Plans	$173 - $201	1212%
Multiplan/Phcs - All Plans	$173 - $201	1212%
Comp Results - All Plans	$207 - $241	1451%
Three Rivers - All Plans	$207 - $241	1451%
Care Partners Mcaid- All Plans	$230 - $268	1612%

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 $150.
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 Hermann Area District Hospital 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.