CMS Price Transparency Data

Hepatitis C antibody test

Facility: Grossmont Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $38
Cash Discount Price: $54
vs. Medicare Baseline: 2.66x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Grossmont Hospital is $38. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $54. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 2.66x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$54

Average discount available for prompt cash payment at this facility.

Insurance Median

$38

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: $54 (378%)

Insurance Median: $38 (266%)

Cash: $54 (378% of Medicare)

Ins. Median: $38 (266% 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 266% of the Medicare baseline (a markup of 166%). 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 Shield	$2 - $102	14%
Epic Americas	$4 - $9	28%
Multiplan	$4 - $80	28%
Blue Cross Blue Shield	$5 - $96	35%
Molina	$5 - $88	35%
Aetna	$6 - $96	42%
UnitedHealthcare	$6 - $90	42%
Health Net	$7 - $105	49%
Community Health Group	$8 - $87	56%
California Health And Wellness	$10 - $19	70%
Indian Health Council	$10 - $64	70%
Kaiser	$10	70%
Managed Health Network	$10 - $11	70%
San Diego Pace	$10	70%
Humana	$11 - $36	77%
Medicare (plans)	$11 - $99	77%
Interplan	$12 - $90	84%
Allianz Global Assistance	$13 - $96	91%
Cigna	$15 - $86	105%
County Medical Services	$80 - $86	561%
Medi-Cal	$88	617%

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 $54.
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 Grossmont 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.