CMS Price Transparency Data

Hepatitis C antibody test

Facility: Samaritan Medical Center

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $19
Cash Discount Price: $256
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Samaritan Medical Center is $19. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $256. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 1.33x the Medicare baseline. Located in 830 Washington Street, Watertown, NY.

Cash / Self-Pay

$256

Average discount available for prompt cash payment at this facility.

Insurance Median

$19

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: $256 (1794%)

Insurance Median: $19 (133%)

Cash: $256 (1794% of Medicare)

Ins. Median: $19 (133% 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.

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
Capital District Physician'S Health Plan, Inc (Cdphp)	$14 - $204	98%
Excellus	$14 - $66	98%
Fidelis	$14 - $16	98%
Wellcare	$14	98%
Aetna	$15 - $217	105%
Mvp	$15 - $173	105%
UnitedHealthcare	$15 - $217	105%
Ghi Emblem	$192	1345%

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 $256.
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 Samaritan Medical Center 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.