CMS Price Transparency Data

Hepatitis C antibody test

Facility: Valley Presbyterian Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $43
Cash Discount Price: $74
vs. Medicare Baseline: 3.01x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Valley Presbyterian Hospital is $43. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $74. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 3.01x the Medicare baseline. Located in 15107 Vanowen St, Van Nuys, CA.

Cash / Self-Pay

$74

Average discount available for prompt cash payment at this facility.

Insurance Median

$43

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: $74 (519%)

Insurance Median: $43 (301%)

Cash: $74 (519% of Medicare)

Ins. Median: $43 (301% 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 301% of the Medicare baseline (a markup of 201%). 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
Aetna	$14 - $56	98%
Blue Cross Blue Shield	$14 - $43	98%
Blue Shield Senior	$14	98%
Health Net Senior	$14	98%
La Care Covered California	$14	98%
Medicare (plans)	$14 - $15	98%
Blue Shield Promise Medi-Cal	$15 - $22	105%
Ambetter / Centene	$20	140%
Heritage Provider Network (Regal & Lakeside)	$22	154%
Health Net	$28	196%
La Care Medi-Cal	$36 - $52	252%
Phcs	$36 - $52	252%
Blue Shield Ifp	$42 - $62	294%
Coventry Health Care (Ccn)	$42 - $61	294%
UnitedHealthcare	$43 - $68	301%
Beech Street	$45 - $65	315%
Cigna	$47	329%
Blue Shield	$48 - $70	336%
Multiplan	$54 - $78	378%

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 $74.
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 Valley Presbyterian 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.