CMS Price Transparency Data

Hepatitis C antibody test

Facility: North Austin Medical Center

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $56
  • Cash Discount Price: $442
  • vs. Medicare Baseline: 3.92x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at North Austin Medical Center is $56. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $442. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 3.92x the Medicare baseline. Located in 12221 Mopac Expressway North, Austin, TX.
Cash / Self-Pay
$442

Average discount available for prompt cash payment at this facility.

Insurance Median
$56

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: $442 (3097%)
Insurance Median: $56 (392%)
Cash: $442 (3097% of Medicare)
Ins. Median: $56 (392% 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 392% of the Medicare baseline (a markup of 292%). 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.

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
Superior Health Plan $10 - $115 70%
St David’S Hospice $12 - $14 84%
United $12 - $305 84%
Blue Cross Blue Shield $13 - $200 91%
Molina Healthcare $13 - $16 91%
Aetna $14 - $15 98%
Cigna $14 - $40 98%
Devoted Health $14 98%
Humana $14 - $15 98%
Odyssey Hospice $14 98%
Triwest Healthcare Alliance $14 98%
UnitedHealthcare $14 - $305 98%
Wellmed $14 98%
American Health Plan Of Texas $15 105%
Provider Partners Health Plan $15 105%
Pyramid Life $15 105%
Sendero $15 - $24 105%
Shared Health $15 105%
Texas Independent Health Plan $15 105%
Wellcare $15 105%
Imperial Insurance $16 112%
Triwest Health Alliance $16 112%
Universal Health $17 119%
Austin Fc $18 126%
Amerigroup $20 140%
Naphcare $22 154%
Seven Corners $22 154%
Corvel Corporation $28 196%
Oscar $39 - $44 273%
Moda $49 - $159 343%
Covenant Management Systems $60 - $195 420%
Healthcare Highways $60 - $203 420%
Imo Med - Select Network $62 - $203 434%
Nomi Health $66 - $250 463%
Moda Health $75 - $250 526%
Evry Health $76 - $249 533%
Texas Healthcare Foundation Heb $77 - $250 540%
Texas Workforce Commission $81 - $264 568%
Harbor Health Team $83 - $271 582%
Averde Health $93 - $305 652%
Comanche County $104 - $338 729%
National Choicecare $104 - $338 729%
Healthsmart Preferred Care $114 - $542 799%
Independent Medical Systems $114 - $372 799%
Physicians Cooperative Of Texas $114 - $372 799%
Prime Health $124 - $406 869%
First Health $129 - $481 904%
Coastal Comp Health Networks $135 - $440 946%
National Health Care $135 - $440 946%
Texas Municipal League $145 - $474 1016%
Medcorp Southwest $155 - $508 1086%
Rockport Healthcare Group $166 - $609 1163%
Bce Emergis Corporation $186 - $609 1303%
Beech Street $186 - $609 1303%
Medical Control Network Solutions $186 - $609 1303%
Multiplan $186 - $609 1303%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 12221 Mopac Expressway North, Austin, TX 78758
  • CMS Rating: ★★★☆☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals