CMS Price Transparency Data

Hepatitis C antibody test

Facility: City of Hope National Medical Center

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $13
Cash Discount Price: $40
vs. Medicare Baseline: 0.91x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at City of Hope National Medical Center is $13. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $40. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 0.91x the Medicare baseline. Located in 1500 Duarte Rd, Duarte, CA.

Cash / Self-Pay

$40

Average discount available for prompt cash payment at this facility.

Insurance Median

$13

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: $40 (280%)

Insurance Median: $13 (91%)

Cash: $40 (280% of Medicare)

Ins. Median: $13 (91% 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.

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 Cross Blue Shield	$3 - $138	21%
Heritage Provider Network	$3 - $51	21%
Blue Shield	$4 - $94	28%
Blue Shield Covca	$4 - $44	28%
Blue Shield Promise	$4 - $51	28%
UnitedHealthcare	$4 - $43	28%
Cencal	$5 - $59	35%
Inland Empire	$5 - $59	35%
La Care Health	$5 - $59	35%
Aetna	$6 - $73	42%
Gold Coast	$6 - $73	42%
Health Net	$6 - $71	42%
Kaiser	$6 - $66	42%
Molina	$6 - $95	42%
Prime Healthcare Keenan	$6 - $70	42%
Cigna	$7 - $79	49%
Healthcare Partners	$7 - $85	49%
Primecare Medical Network	$8 - $95	56%
St. Joseph Heritage	$8 - $88	56%
First Health	$10 - $113	70%
Phcs Multiplan	$11 - $132	77%
Cal Optima	$13 - $18	91%
Facey	$13 - $19	91%

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 $40.
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 City of Hope National Medical Center 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.