CMS Price Transparency Data

Hepatitis C antibody test

Facility: Essentia Health

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $52
  • Cash Discount Price: $87
  • vs. Medicare Baseline: 3.64x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at Essentia Health is $52. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $87. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 3.64x the Medicare baseline. Located in 3000 32Nd Ave South, Fargo, ND.
Cash / Self-Pay
$87

Average discount available for prompt cash payment at this facility.

Insurance Median
$52

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: $87 (610%)
Insurance Median: $52 (364%)
Cash: $87 (610% of Medicare)
Ins. Median: $52 (364% 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 364% of the Medicare baseline (a markup of 264%). 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
Advocare/Security Health $14 98%
Blue Cross Blue Shield $14 - $103 98%
Freedom Blue Ppo $14 98%
Healthpartners Care Msho / Mcr Adv $14 98%
Imcare Msho Pcc Prime $14 98%
Imcare Msho Ref Req $14 98%
Itasca Med Care $14 98%
Medica Advantage Solutions $14 98%
Medica Msho/Dual Solutions $14 98%
Medica Prime Solution Group $14 98%
Medicare (plans) $14 98%
Nd Va Administration $14 98%
Platinum Blue/Vantage Blue $14 98%
Primewest $14 98%
Primewest Msho $14 98%
Secure Blue Msho $14 98%
Ubh Cost Plan $14 98%
Ubh Msho $14 98%
Ucare Msho $14 98%
UnitedHealthcare $14 - $122 98%
Medica Access $21 - $41 147%
Healthpartners Care Pmap $30 - $60 210%
Sanford Health Plan $33 - $69 231%
Medica $43 - $94 301%
Medica Uplan $43 - $85 301%
Medica Choice $49 - $97 343%
Ucare $51 - $101 357%
Cigna $52 - $103 364%
Healthpartners $52 - $103 364%
Healthpartners Pcc Prime $52 - $103 364%
Wea $56 - $118 392%
America'S Ppo $60 - $119 420%
Wps $65 - $129 456%
Aetna $66 - $130 463%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3000 32Nd Ave South, Fargo, ND 58104
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals