CMS Price Transparency Data

Hepatitis C antibody test

Facility: Porter Hospital Inc

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $65
  • Cash Discount Price: $118
  • vs. Medicare Baseline: 4.56x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at Porter Hospital Inc is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $118. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 4.56x the Medicare baseline. Located in 115 Porter Drive, Middlebury, VT.
Cash / Self-Pay
$118

Average discount available for prompt cash payment at this facility.

Insurance Median
$65

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: $118 (827%)
Insurance Median: $65 (456%)
Cash: $118 (827% of Medicare)
Ins. Median: $65 (456% 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 456% of the Medicare baseline (a markup of 356%). 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
Humana $14 98%
Fidelis Care $50 350%
Aetna $55 385%
Capital District Physicians' Health Plan $55 - $98 385%
Martins Point $55 385%
Mvp $55 - $110 385%
UnitedHealthcare $55 - $117 385%
Veterans Affairs Community Care Network $55 385%
Veterans Choice $55 385%
Blue Cross Blue Shield $57 - $115 399%
Wellpath $65 456%
Harvard Pilgrim $94 659%
Coventry $104 729%
Cigna $107 750%
Medical Corporation $112 785%
Multiplan $112 785%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 115 Porter Drive, Middlebury, VT 05753
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals