CMS Price Transparency Data
Hepatitis C antibody test
Facility: St Charles Madras
Billing Code: 86803 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 86803
- Insurance Median: $62
- Cash Discount Price: $81
- vs. Medicare Baseline: 4.34x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at St Charles Madras is $62. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $81. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 4.34x the Medicare baseline. Located in 470 Ne A Street, Madras, OR.
Cash / Self-Pay
$81
Average discount available for prompt cash payment at this facility.
Insurance Median
$62
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: $81 (568%)
Insurance Median: $62 (434%)
Cash: $81 (568% of Medicare)
Ins. Median: $62 (434% 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 434% of the Medicare baseline (a markup of 334%). 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 | $11 - $42 | 77% |
| Pacificsource Community Solutions [525] | $12 - $13 | 84% |
| Tricare | $13 | 91% |
| Aetna | $14 - $90 | 98% |
| Ageright Advantage [142] | $14 | 98% |
| Asuris Northwest Health [202] | $14 | 98% |
| Blue Cross Blue Shield | $14 - $43 | 98% |
| Champ Va [700] | $14 | 98% |
| Cigna | $14 - $65 | 98% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $14 | 98% |
| Devoted Health Inc [145] | $14 | 98% |
| Health Market Care Assured [134] | $14 | 98% |
| Health Net Med Adv [135] | $14 | 98% |
| Healthcare Management Admin [201] | $14 | 98% |
| Humana | $14 | 98% |
| Indian Health [704] | $14 | 98% |
| Kaiser Permanente Med Adv [136] | $14 | 98% |
| Law Enforcement [701] | $14 - $51 | 98% |
| Medicare (plans) | $14 - $29 | 98% |
| Regence Group Administrators [203] | $14 | 98% |
| Samaritan Health Plan Med Adv [141] | $14 | 98% |
| Unicare [133] | $14 | 98% |
| UnitedHealthcare | $14 - $96 | 98% |
| Veterans [706] | $14 | 98% |
| Wellcare [132] | $14 | 98% |
| Otj Dept Of Labor Federal Emp [652] | $18 | 126% |
| Otj Us Department Of Labor [669] | $18 | 126% |
| Kaiser Permanente [334] | $26 - $90 | 182% |
| Pacificsource [345] | $26 - $57 | 182% |
| Advanced Health [534] | $27 - $42 | 189% |
| Allcare Health Plan [538] | $27 - $42 | 189% |
| Cascade Health Alliance [532] | $27 - $42 | 189% |
| Columbia Pacific Coordinated Care Llc [539] | $27 - $42 | 189% |
| Health Share Care Oregon [526] | $27 - $42 | 189% |
| Health Share Kaiser [543] | $27 - $42 | 189% |
| Health Share Ohsu Ohp [552] | $27 - $42 | 189% |
| Health Share Providence [548] | $27 - $42 | 189% |
| Health Share [537] | $27 - $42 | 189% |
| Intercommunity Health [530] | $27 - $42 | 189% |
| Jackson Care Connect [542] | $27 - $42 | 189% |
| Primary Health Of Jospehine County Llc [547] | $27 - $42 | 189% |
| Umpqua Health [533] | $27 - $42 | 189% |
| Willamette Valley Community Health [536] | $27 - $42 | 189% |
| Yamhill County Coordinated Care Org [550] | $27 - $42 | 189% |
| Moda [310] | $29 - $89 | 203% |
| Providence Health Plan [347] | $29 - $91 | 203% |
| Us Benefits [326] | $41 - $65 | 287% |
| Bridgespan [342] | $43 | 301% |
| Rocky Mountain Administrators [405] | $53 - $83 | 371% |
| Rx Internal [4100003] | $54 - $85 | 378% |
| First Choice Health [317] | $57 - $90 | 399% |
| Meritain Health [300] | $57 - $90 | 399% |
| Samaritan [376] | $57 - $90 | 399% |
| Health Net [340] | $62 - $97 | 434% |
| Administrative Concepts Inc [402] | $65 - $102 | 456% |
| First Health [339] | $65 - $102 | 456% |
| Manhattan Life Insurance Company [379] | $65 - $102 | 456% |
| Philadelphia American Life Insurance Company [395] | $65 - $102 | 456% |
| Planned Administrators Inc [375] | $65 - $102 | 456% |
| Auto Allstate Insurance [602] | $66 - $104 | 463% |
| Auto American Family Insurance [603] | $66 - $104 | 463% |
| Auto Country Insurance Claims [604] | $66 - $104 | 463% |
| Auto Dairyland Insurance [617] | $66 - $104 | 463% |
| Auto Farmers [605] | $66 - $104 | 463% |
| Auto Geico Claims Oregon [606] | $66 - $104 | 463% |
| Auto Hartford [612] | $66 - $104 | 463% |
| Auto Liberty Mutual Auto Ins [613] | $66 - $104 | 463% |
| Auto Mutual Of Enumclaw [610] | $66 - $104 | 463% |
| Auto Nationwide Allied Insuranc [601] | $66 - $104 | 463% |
| Auto Oregon Mutual [614] | $66 - $104 | 463% |
| Auto Progressive [608] | $66 - $104 | 463% |
| Auto Safeco Concentra [600] | $66 - $104 | 463% |
| Auto State Farm Claims [609] | $66 - $104 | 463% |
| Auto Sublimity Insurance [616] | $66 - $104 | 463% |
| Auto Travelers Insurance [615] | $66 - $104 | 463% |
| Auto Usaa [611] | $66 - $104 | 463% |
| Generic Auto [649] | $66 - $104 | 463% |
| Generic Workers Comp [699] | $66 - $104 | 463% |
| Otj Broadspire Services [670] | $66 - $104 | 463% |
| Otj Ccmsi [618] | $66 - $104 | 463% |
| Otj Chartis Claims [650] | $66 - $104 | 463% |
| Otj City County Ins Services [662] | $66 - $104 | 463% |
| Otj Corvel [676] | $66 - $104 | 463% |
| Otj Esis West Wc Claims [653] | $66 - $104 | 463% |
| Otj Gallagher Bassett [654] | $66 - $104 | 463% |
| Otj Hartford [655] | $66 - $104 | 463% |
| Otj Intermountain Claims Inc [666] | $66 - $104 | 463% |
| Otj Liberty Mutual Wausau Underwriters [671] | $66 - $104 | 463% |
| Otj Penser No American [663] | $66 - $104 | 463% |
| Otj Pinnacle Risk Mgmt [661] | $66 - $104 | 463% |
| Otj Saif [667] | $66 - $104 | 463% |
| Otj Sedgwick Cms [660] | $66 - $104 | 463% |
| Otj Sedgwick [668] | $66 - $104 | 463% |
| Otj Travelers Insurance [672] | $66 - $104 | 463% |
| Otj Tristar [673] | $66 - $104 | 463% |