CMS Price Transparency Data

Hepatitis C antibody test

Facility: Black River Memorial Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $187
Cash Discount Price: $183
vs. Medicare Baseline: 13.10x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Black River Memorial Hospital is $187. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $183. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 13.10x the Medicare baseline. Located in 711 W Adams St, Black River Falls, WI.

Cash / Self-Pay

$183

Average discount available for prompt cash payment at this facility.

Insurance Median

$187

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: $183 (1282%)

Insurance Median: $187 (1310%)

Cash: $183 (1282% of Medicare)

Ins. Median: $187 (1310% 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 1310% of the Medicare baseline (a markup of 1210%). 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
Blue Cross Blue Shield	$11 - $104	77%
Group Health Cooperative Of Eau Claire	$15 - $197	105%
My Choice Wisconsin, Inc.	$15 - $104	105%
Quartz Health Solutions, Inc	$15 - $185	105%
UnitedHealthcare	$15 - $191	105%
Humana	$104 - $189	729%
Security Health Plan	$104 - $190	729%
Corvel	$124	869%
The Alliance	$173 - $195	1212%
Triology Health Solutions	$183 - $193	1282%
Medica	$190	1331%
Association Benefits Solution	$193	1352%
Family Health Center Of Marshfield	$193	1352%
First Health Group Corporation	$193	1352%
Provider Network Of America	$193	1352%
Cigna	$197	1381%
Cofinity	$197	1381%
Coventry Health Care	$197	1381%
Custom Benefit Administrators	$197	1381%
Healthpartners, Inc.	$197	1381%
Multiplan	$197 - $201	1381%
Wisconsin Physicians Service Insurance Corp	$197	1381%
Chorus	$199	1395%

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 $183.
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 Black River 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.