CMS Price Transparency Data

Hepatitis C antibody test

Facility: Adventist Health Sierra Vista

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $84
Cash Discount Price: $22
vs. Medicare Baseline: 5.89x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Adventist Health Sierra Vista is $84. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $22. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 5.89x the Medicare baseline. Located in 1010 Murray St, San Luis Obispo, CA.

Cash / Self-Pay

$22

Average discount available for prompt cash payment at this facility.

Insurance Median

$84

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: $22 (154%)

Insurance Median: $84 (589%)

Cash: $22 (154% of Medicare)

Ins. Median: $84 (589% 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 589% of the Medicare baseline (a markup of 489%). 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 Epn	$2 - $100	14%
Blue Shield Hmo/Pos	$2 - $124	14%
Medi-Cal	$4 - $255	28%
Ccah-Centrl Ca Allince Mcal-All Plans	$5 - $332	35%
Cencal Mcal	$5 - $291	35%
Coalinga-All Plans	$5 - $332	35%
Aetna	$14	98%
Cencal Mcr Adv - All Other Plans	$14	98%
Tricare	$14	98%
UnitedHealthcare	$14 - $88	98%
Cfmg-Ca Forensic Med Grp Op/Profee Only-All Plans	$19	133%
Ah Employee Health Plan - All Plans	$26	182%
Nbd-Ntwrks By Design Non-Exclus	$31 - $147	217%
Hpn-Heritage Prov Ntwrk-All Plans	$87	610%
Blue Shield Epo/Ppo-All Other Plans	$126 - $137	883%
Nbd-Ntwrks By Design Exclus-All Other Plans	$135 - $147	946%
Blue Shield Promise Mcal	$281 - $307	1969%

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 $22.
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 Sierra Vista 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.