CMS Price Transparency Data
Hepatitis C antibody test
Facility: Saint Alphonsus Medical Center Ontario
Billing Code: 86803 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 86803
- Insurance Median: $34
- Cash Discount Price: $72
- vs. Medicare Baseline: 2.38x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at Saint Alphonsus Medical Center Ontario is $34. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 2.38x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.
Cash / Self-Pay
$72
Average discount available for prompt cash payment at this facility.
Insurance Median
$34
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: $72 (505%)
Insurance Median: $34 (238%)
Cash: $72 (505% of Medicare)
Ins. Median: $34 (238% 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 238% of the Medicare baseline (a markup of 138%). 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $10 - $41 | 70% |
| Aetna | $14 - $129 | 98% |
| Blue Cross Blue Shield | $14 - $116 | 98% |
| Medicare (plans) | $14 - $15 | 98% |
| UnitedHealthcare | $14 - $131 | 98% |
| American Health Advantage Of Idaho | $15 | 105% |
| Healthnet | $15 | 105% |
| Healthcare Management Admin | $24 | 168% |
| Ada County Jail Inmate Ins | $25 - $41 | 175% |
| Ambetter / Centene | $25 - $41 | 175% |
| Amish Mennonite | $25 - $41 | 175% |
| Bcccp-Michigan | $25 - $41 | 175% |
| Bccp | $25 - $41 | 175% |
| Blue Benefit Administrators Of Massachusetts | $25 | 175% |
| Blue Care Network | $25 | 175% |
| Blue Distinction Transplant | $25 | 175% |
| Blue Shield - Ca | $25 | 175% |
| Blue Shield - Id (Regence) | $25 | 175% |
| Blue Shield - Ny Highmark Northeastern | $25 | 175% |
| Blue Shield - Ny Highmark Western | $25 | 175% |
| Blue Shield - Pa (Highmark) | $25 | 175% |
| Blue Shield - Wa (Regence) | $25 | 175% |
| Bmc Healthnet | $25 - $41 | 175% |
| Breast Grant-Connecticut | $25 - $41 | 175% |
| California Health And Wellness | $25 - $41 | 175% |
| Cardinal Innovations Lme | $25 - $41 | 175% |
| Care Oregon Ohp | $25 - $41 | 175% |
| Cencal Health Plan | $25 - $41 | 175% |
| Cenpatico | $25 - $41 | 175% |
| Centurion Of Idaho | $25 - $41 | 175% |
| Chhuny | $25 - $41 | 175% |
| Childrens Comm Health Plan | $25 - $41 | 175% |
| Childrens Medical Services Title 19 | $25 - $41 | 175% |
| Cigna | $25 - $128 | 175% |
| Community Benefit Health | $25 - $41 | 175% |
| Community Care Behavorial Health | $25 - $41 | 175% |
| Community Health Choice | $25 - $41 | 175% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $25 - $41 | 175% |
| Dean Wi Badgercare | $25 - $41 | 175% |
| Delaware First Health | $25 - $41 | 175% |
| Delta Dental Nj | $25 - $41 | 175% |
| Dph Tb Program | $25 - $41 | 175% |
| Dscc | $25 - $41 | 175% |
| Eastpointe Lme | $25 - $41 | 175% |
| Family Health Network | $25 - $41 | 175% |
| Freedom First Healthcare | $25 - $41 | 175% |
| Ghc Scw Wi Badgercare | $25 - $41 | 175% |
| Harbor Health | $25 - $41 | 175% |
| Health Safety Net | $25 - $41 | 175% |
| Healthy Blue Ne | $25 - $41 | 175% |
| Hennepin Health | $25 - $41 | 175% |
| Humana | $25 - $120 | 175% |
| Id County Ada | $25 - $41 | 175% |
| Id County Canyon | $25 - $41 | 175% |
| Id County Cat Fund | $25 - $41 | 175% |
| Id County Payette | $25 - $41 | 175% |
| Idaho Womens Health Check | $25 - $41 | 175% |
| Indiana Breast Cervical Cancer | $25 - $41 | 175% |
| Inland Empire Health Plan | $25 - $41 | 175% |
| Intercommunity Health Ohp | $25 - $41 | 175% |
| Iowa Total Care | $25 - $41 | 175% |
| Jai Medical System | $25 - $41 | 175% |
| Kern Family Health Plan | $25 - $41 | 175% |
| Keystone First | $25 - $41 | 175% |
| Keystone First Chip | $25 - $41 | 175% |
| La Care Health Plan | $25 - $41 | 175% |
| Lakeland Care Inc | $25 - $41 | 175% |
| Managed Health Services - Indiana | $25 - $41 | 175% |
| Maryland Breast & Cervical Program | $25 - $41 | 175% |
| Maryland Healthy Smiles - Scion Dental | $25 - $41 | 175% |
| Maryland Physicians Care | $25 - $41 | 175% |
| Massachusetts Behavioral Health Partnership | $25 - $41 | 175% |
| Mdwise | $25 - $41 | 175% |
| Medi-Cal | $25 - $41 | 175% |
| Medi-Cal Healthnet | $25 - $41 | 175% |
| Medstar Dc Healthy Family | $25 - $41 | 175% |
| Medstar Md Health Choice | $25 - $41 | 175% |
| Mo Home State Health Plan | $25 - $41 | 175% |
| Molina Centennial Care | $25 - $41 | 175% |
| Nascentia Health Options | $25 - $41 | 175% |
| Nebraska Total Care | $25 - $41 | 175% |
| New York Cancer Services Program | $25 - $41 | 175% |
| Nextlevel Health | $25 - $41 | 175% |
| Oregon Screenwise | $25 - $41 | 175% |
| Pace Of Southwest Michigan | $25 - $41 | 175% |
| Paramount Advantage | $25 - $41 | 175% |
| Parkland Community Health Plan | $25 - $41 | 175% |
| Partners Behavioral Lme | $25 - $41 | 175% |
| Peach State Healthplan | $25 - $41 | 175% |
| Presbyterian Centennial Care | $25 - $41 | 175% |
| Prestige Health Choice | $25 - $41 | 175% |
| Priority Partners | $25 - $41 | 175% |
| Rx 340B Pass Along | $25 - $41 | 175% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $25 - $41 | 175% |
| Rx Medi-Cal | $25 - $41 | 175% |
| Rx Meridian Rx | $25 - $41 | 175% |
| Sandhills Center Lme | $25 - $41 | 175% |
| Screening For Life | $25 - $41 | 175% |
| Sunshine State Health Plan | $25 - $41 | 175% |
| Superior Health | $25 - $41 | 175% |
| Tenncare | $25 - $41 | 175% |
| Texas Children'S Health Plan | $25 - $41 | 175% |
| Trillium Community Ohp | $25 - $41 | 175% |
| Tufts Health Public Plans | $25 - $41 | 175% |
| Vaya Health Lme | $25 - $41 | 175% |
| Wellsense Health Plan | $25 - $41 | 175% |
| Wi Womens Wellness | $25 - $41 | 175% |
| Moda Health | $28 - $132 | 196% |
| Webtpa | $38 - $122 | 266% |
| Mountain Health Co-Op | $50 - $82 | 350% |
| Pacificsource Health Plans | $50 - $128 | 350% |
| Selecthealth | $54 - $122 | 378% |
| Allegiance | $63 - $103 | 441% |
| Correctional Health Partners | $65 - $106 | 456% |
| Columbia Health Network | $66 - $109 | 463% |
| Allied National Global Care | $75 - $122 | 526% |
| Asrm - Reliance Standard Life Insurance | $75 - $122 | 526% |
| Christian Care Ministry | $75 - $122 | 526% |
| Dean Health | $75 - $122 | 526% |
| Fallon Health | $75 - $122 | 526% |
| Family Life Insurance Company | $75 - $122 | 526% |
| First Choice Health | $75 - $122 | 526% |
| Ghc Scw | $75 - $122 | 526% |
| International Benefit Administrators | $75 - $122 | 526% |
| Lifetime Benefit Solutions | $75 - $122 | 526% |
| Manhattan Life | $75 - $122 | 526% |
| Pai | $75 - $122 | 526% |
| Pan-American Life | $75 - $122 | 526% |
| Paramount Hmo | $75 - $122 | 526% |
| Phcs | $75 - $122 | 526% |
| Trinity Health Share | $75 - $122 | 526% |
| Lifewise | $77 - $126 | 540% |
| Priority Health | $78 - $128 | 547% |
| Allied Benefit Systems | $79 - $129 | 554% |
| Ameriben | $79 - $129 | 554% |
| Asr Health Benefits | $79 - $129 | 554% |
| Christian Brother Services | $79 - $129 | 554% |
| First Health | $79 - $129 | 554% |
| Geha | $79 - $131 | 554% |
| Healthez | $79 - $129 | 554% |
| Luminare Health (Detroit) | $79 - $129 | 554% |
| Medi Share | $79 - $129 | 554% |
| Providence | $79 - $129 | 554% |
| Rural Carrier Health Benefit Plan | $79 - $129 | 554% |