CMS Price Transparency Data

Hepatitis C antibody test

Facility: Mary Hitchcock Memorial Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $58
Cash Discount Price: $37
vs. Medicare Baseline: 4.06x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Mary Hitchcock Memorial Hospital is $58. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $37. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 4.06x the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.

Cash / Self-Pay

$37

Average discount available for prompt cash payment at this facility.

Insurance Median

$58

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: $37 (259%)

Insurance Median: $58 (406%)

Cash: $37 (259% of Medicare)

Ins. Median: $58 (406% 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 406% of the Medicare baseline (a markup of 306%). 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	$6 - $190	42%
Blue Cross Blue Shield	$9 - $216	63%
Amerihealth Caritas Nh	$11 - $28	77%
Beacon Health Strategies/Carelon	$12 - $30	84%
Granite State Health Plan	$12 - $31	84%
Wellsense Health Plan	$12 - $30	84%
Harvard Pilgrim Health Care Of Ne	$14 - $159	98%
Martin'S Point Generations Advantage	$14	98%
Mvp	$14 - $166	98%
Aetna	$15 - $174	105%
Ambetter / Centene	$15 - $47	105%
Cigna	$15 - $170	105%
Martin'S Point Health Care	$15 - $86	105%
Wellcare Health Plans	$15	105%
Mass General Brigham Health Plan	$34 - $154	238%
Tufts Health Plan	$41 - $145	287%
Maine Community Health Options	$63 - $182	441%
Coventry	$86 - $216	603%
First Health/Hcvm	$86 - $216	603%
Phcs	$89 - $223	624%
Corvel	$91 - $228	638%
Ccmsi	$94 - $236	659%

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 $37.
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 Mary Hitchcock Memorial 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.