CMS Price Transparency Data

Hepatitis C antibody test

Facility: Adventist Health and Rideout

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $47
Cash Discount Price: $15
vs. Medicare Baseline: 3.29x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Adventist Health and Rideout is $47. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 3.29x the Medicare baseline. Located in 726 4Th St, Marysville, CA.

Cash / Self-Pay

$15

Average discount available for prompt cash payment at this facility.

Insurance Median

$47

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: $15 (105%)

Insurance Median: $47 (329%)

Cash: $15 (105% of Medicare)

Ins. Median: $47 (329% 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 329% of the Medicare baseline (a markup of 229%). 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
Healthnet Mcal	$3 - $56	21%
Bc Mcal	$4	28%
Healthnet Comm-All Other Plans	$8 - $167	56%
Aetna	$9 - $197	63%
Blue Cross Blue Shield	$10 - $214	70%
Blue Shield Uc Care Members	$10 - $222	70%
Kaiser-All Other Plans	$10 - $211	70%
UnitedHealthcare	$10 - $241	70%
Cigna	$11 - $237	77%
First Health-All Plans	$11 - $243	77%
Interplan-All Plans	$11 - $250	77%
Phcs-All Plans	$11 - $245	77%
Blue Shield-All Other Plans	$12 - $264	84%
Multiplan-All Plans	$12 - $264	84%
Ca Health And Wellness- All Plans	$13 - $20	91%
Celtic Mcaid-All Plans	$13 - $20	91%
Kaiser Mcal	$13 - $16	91%
Medi-Cal	$13 - $16	91%
Partnership Hp Mcal -All Plans	$13 - $16	91%
Kaiser Mcr Adv	$14	98%
Tricare	$14	98%
Ah Employee Health Plan - All Plans	$26	182%

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 $15.
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 Adventist Health and Rideout 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.