CMS Price Transparency Data

Hepatitis C antibody test

Facility: Prosser Memorial Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $56
Cash Discount Price: $39
vs. Medicare Baseline: 3.92x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Prosser Memorial Hospital is $56. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $39. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 3.92x the Medicare baseline. Located in 723 Memorial Street, Prosser, WA.

Cash / Self-Pay

$39

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: $39 (273%)

Insurance Median: $56 (392%)

Cash: $39 (273% 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.

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
Kaiser Permanente	$14 - $64	98%
Community Health Plan Of Washington	$15 - $28	105%
Coordinated Care	$15 - $28	105%
UnitedHealthcare	$15 - $28	105%
Amerigroup	$16 - $30	112%
Molina	$16 - $28	112%
Health Alliance Northwest	$18	126%
Humana	$18 - $60	126%
Wellcare	$18	126%
Aetna	$21 - $60	147%
Ambetter / Centene	$49 - $54	343%
Asuris	$56 - $63	392%
Health Management Adminstrators	$56 - $63	392%
Premera	$56	392%
Regence	$56 - $63	392%
Cigna	$57	399%
First Choice	$60	420%
Multiplan	$60 - $63	420%

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 $39.
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 Prosser 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.