CMS Price Transparency Data

Hepatitis C antibody test

Facility: Marshfield Medical Center

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $282
Cash Discount Price: $315
vs. Medicare Baseline: 19.76x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Marshfield Medical Center is $282. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $315. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 19.76x the Medicare baseline. Located in 611 St Joseph Ave, Marshfield, WI.

Cash / Self-Pay

$315

Average discount available for prompt cash payment at this facility.

Insurance Median

$282

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: $315 (2207%)

Insurance Median: $282 (1976%)

Cash: $315 (2207% of Medicare)

Ins. Median: $282 (1976% 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 1976% of the Medicare baseline (a markup of 1876%). 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
Security Health Plan (Shp)	$14 - $98	98%
Veteran'S Administration (Va Ccn)	$14	98%
Blue Cross Blue Shield	$15 - $89	105%
Group Health Cooperative Of Eau Claire	$15 - $305	105%
Managed Health Services	$16	112%
UnitedHealthcare	$50	350%
Family Health Center (Fhc)	$166	1163%
Amish/Mennonite	$183	1282%
Sanford Health Plan	$183	1282%
The Alliance	$231 - $277	1619%
Besse Forest Products	$282	1976%
Molina Healthcare Of Wi	$282	1976%
Rice Lake School District	$282	1976%
Wps Health Insurance	$293 - $320	2053%
Trilogy	$299 - $319	2095%
Medica Of Wi	$308 - $314	2158%
Cigna	$312	2186%
Healtheos By Multiplan Inc.	$312 - $315	2186%
Corvel	$315	2207%
First Health	$315	2207%
Health Partners	$315	2207%
Three Rivers Provider Network (Trpn)	$315	2207%
Coventry	$319	2235%
Health Smart	$319	2235%
Rising Medical Work Comp	$322	2256%

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 $315.
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 Marshfield Medical Center 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.