CMS Price Transparency Data

Hepatitis C antibody test

Facility: Ira Davenport Memorial Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $235
Cash Discount Price: $228
vs. Medicare Baseline: 16.47x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Ira Davenport Memorial Hospital is $235. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $228. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 16.47x the Medicare baseline. Located in 7571 State Route 54, Bath, NY.

Cash / Self-Pay

$228

Average discount available for prompt cash payment at this facility.

Insurance Median

$235

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: $228 (1598%)

Insurance Median: $235 (1647%)

Cash: $228 (1598% of Medicare)

Ins. Median: $235 (1647% 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 1647% of the Medicare baseline (a markup of 1547%). 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
Empire	$6	42%
Blue Cross Blue Shield	$12 - $1,144	84%
Amerihealth Caritas Mcr Adv - All Plans	$14	98%
Humana	$14 - $339	98%
Tricare	$14	98%
Fidelis	$15	105%
UnitedHealthcare	$29 - $396	203%
Fidelis Care - Exchange - All Plans	$207	1451%
Geisinger - All Plans	$219	1535%
Cigna	$235	1647%
Mvp Health Plan - All Plans	$235	1647%
Independent Health - All Plans	$245	1717%
Upmc - All Plans	$260	1822%
Pomco Inc - All Plans	$272	1906%
Aetna	$283 - $337	1983%
Emblem Health - All Plans	$332	2327%
Emblem/Ghi	$349	2446%
Martins Point - All Plans	$377	2642%
Healthnow - All Plans	$1,242	8704%

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 $228.
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 Ira Davenport 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.