Hepatitis C Antibody Measurement
What Medicare pays for 86803, what providers bill, and how the price varies across 52 states, drawn from CMS 2023 claims data.
86803 · the short answer
For hepatitis c antibody measurement, Medicare pays about $13.92 while providers bill $112.21 on average, a 8.1× markup, a higher-than-typical markup. State-level Medicare rates range 3% from lowest to highest.
- Medicare pays
- $13.92
- Providers bill
- $112.21
- Markup
- 8.1×
- Markup percentile
- 82th
Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Immunology procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Where this markup sits nationally
Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate
8 Among the most affordable more affordable than 82% of 8,901 procedures
Each bar is a band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Medicare Physician & Other Practitioners · 2023
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Delaware | $13.98 | $26.26 |
| New Hampshire | $13.98 | $46.61 |
| Vermont | $13.98 | $67.00 |
| Wyoming | $13.98 | $55.15 |
| U.S. Virgin Islands | $13.98 | $14.34 |
| New Mexico | $13.98 | $70.96 |
| Kansas | $13.97 | $140.34 |
| Puerto Rico | $13.97 | $17.08 |
| Massachusetts | $13.97 | $123.53 |
| Maryland | $13.97 | $123.91 |
| New Jersey | $13.96 | $113.52 |
| New York | $13.96 | $121.77 |
| Georgia | $13.96 | $145.61 |
| Colorado | $13.96 | $98.50 |
| Rhode Island | $13.95 | $55.53 |
| Virginia | $13.95 | $49.15 |
| Texas | $13.95 | $118.30 |
| North Carolina | $13.95 | $96.60 |
| Pennsylvania | $13.95 | $112.59 |
| Kentucky | $13.95 | $46.82 |
| Arizona | $13.94 | $108.62 |
| Nevada | $13.93 | $144.76 |
| Hawaii | $13.93 | $59.77 |
| Utah | $13.93 | $32.08 |
| Maine | $13.92 | $45.48 |
| Illinois | $13.92 | $126.23 |
| Ohio | $13.92 | $88.52 |
| West Virginia | $13.92 | $78.49 |
| Louisiana | $13.91 | $56.59 |
| Michigan | $13.91 | $40.75 |
| Washington | $13.91 | $106.57 |
| Alabama | $13.90 | $93.78 |
| Montana | $13.90 | $42.76 |
| South Dakota | $13.89 | $99.81 |
| Florida | $13.89 | $130.75 |
| California | $13.89 | $129.56 |
| Iowa | $13.88 | $56.84 |
| Oregon | $13.87 | $55.00 |
| Oklahoma | $13.86 | $69.62 |
| Nebraska | $13.86 | $45.51 |
| Mississippi | $13.84 | $89.84 |
| North Dakota | $13.83 | $87.03 |
| Idaho | $13.83 | $36.09 |
| South Carolina | $13.81 | $80.71 |
| Connecticut | $13.81 | $72.58 |
| Indiana | $13.80 | $47.69 |
| Tennessee | $13.79 | $79.96 |
| Missouri | $13.76 | $46.46 |
| Minnesota | $13.75 | $85.91 |
| Alaska | $13.73 | $140.54 |
| Wisconsin | $13.72 | $112.89 |
| Arkansas | $13.64 | $35.02 |
What the Data Says About Hepatitis C Antibody Measurement
Across 52 states with reporting providers, CPT code 86803 (Hepatitis C Antibody Measurement) shows a national average Medicare payment of $13.92 against an average billed charge of $112.21. That gap, a 8.1x markup, or 706% above the Medicare allowed amount, runs well above the median for tracked procedures, a sign the chargemaster rate here is more aspirational than transactional.
Immunology procedures like this one saw 501.5K services billed to Medicare in 2023 by 6.0K distinct providers, serving 463.1K unique beneficiaries. State-level variation is significant: Arkansas reports the lowest average payment at $13.64, while Delaware reports the highest at $13.98. At just 3%, this procedure prices remarkably consistently nationwide, GPCI adjustments barely move the needle for this particular code.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Immunology category (2.24x), the estimated commercial insurance price lands near $31.19, with self-pay cash discounts commonly bringing the figure closer to $41.30. Within Immunology, Hepatitis C Antibody Measurement ranks #111 of 225 tracked procedures by national average Medicare payment.
What to do with this
If you may have hepatitis c antibody measurement done, these steps turn the numbers above into a real-world cost estimate.
- Request a Good Faith Estimate from your provider at least 3 business days before a scheduled procedure, under the No Surprises Act it is an enforceable written price.
- Compare hepatitis c antibody measurement costs in your state, Medicare rates vary by locality. Browse states
- Check a hospital’s published cash price, which is often far below the billed charge. Price transparency
- Understand why billed charges run several times the Medicare rate before you negotiate. Read the guide
Figures here are averages and estimates, not a quote. Confirm coverage and out-of-pocket costs with your insurer and provider.
Frequently Asked Questions
How much does Hepatitis C Antibody Measurement cost?
Hepatitis C Antibody Measurement (CPT 86803) is priced fairly consistently nationwide: Medicare pays $13.92 on average, and the $13.64-$13.98 state range stays relatively tight. Providers typically bill $112.21.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Hepatitis C Antibody Measurement cost with insurance?
With commercial insurance, hepatitis c antibody measurement costs an estimated $31.19 on average (range: $21.83-$43.66), a moderate premium over Medicare's $13.92. Without insurance, the estimated cash price is $41.30.
Which state has the lowest cost for Hepatitis C Antibody Measurement?
Arkansas and Delaware bookend the range for Hepatitis C Antibody Measurement, at $13.64 and $13.98 respectively - a relatively tight $0.34 spread nationwide.
How many providers perform Hepatitis C Antibody Measurement?
A moderate provider base performs Hepatitis C Antibody Measurement: 6.0K providers nationally, totaling 501.5K Medicare-billed services (463.1K beneficiaries) across 52 states in 2023.
What is the billed-to-Medicare markup for Hepatitis C Antibody Measurement?
Providers bill 8.1x what Medicare pays for Hepatitis C Antibody Measurement - a higher-than-typical markup at 706% above the Medicare rate.
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error.