CMS Price Transparency Data

Hepatitis C antibody test

Facility: St Joseph's Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $519
  • Cash Discount Price: $439
  • vs. Medicare Baseline: 36.37x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at St Joseph's Hospital is $519. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $439. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 36.37x the Medicare baseline. Located in 12866 Troxler Avenue, Highland, IL.
Cash / Self-Pay
$439

Average discount available for prompt cash payment at this facility.

Insurance Median
$519

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: $439 (3076%)
Insurance Median: $519 (3637%)
Cash: $439 (3076% of Medicare)
Ins. Median: $519 (3637% 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 3637% of the Medicare baseline (a markup of 3537%). 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
Molina Healthcare $19 - $610 133%
Meridian Health Plan $20 140%
UnitedHealthcare $29 - $610 203%
Caterpillar, Inc. $29 203%
Cigna $35 245%
Sae Hospice $122 - $610 855%
Clear Spring Health of Illinois $122 - $610 855%
Aetna $122 - $610 855%
Blue Cross Blue Shield $122 - $610 855%
Humana $122 - $610 855%
Amish Community $171 1198%
Naphcare $256 - $1,281 1794%
Celtic Insurance Company $268 - $610 1878%
Claim Doc $305 - $1,525 2137%
Hopetrust $305 - $610 2137%
Wellfirst $391 2740%
First Health $451 3160%
Healthlink $518 3630%
Multiplan/Phcs $518 3630%
Provider Network of America $549 3847%
Healthcare Finest Network (Hfn) $549 3847%
Interplan $610 4275%
Current Health Solutions $610 4275%
Healthscope $610 4275%
Illinois Breast and Cervical Cancer Program $610 4275%
Consociate Group $610 4275%
Qtc Medical Group of Illinois $610 4275%
Health Alliance Medical Plans $610 4275%
Mental Health Network $610 4275%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 12866 Troxler Avenue, Highland, IL 62249
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Critical Access Hospitals