CMS Price Transparency Data

Hepatitis C antibody test

Facility: Loma Linda University Children's Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $76
Cash Discount Price: $63
vs. Medicare Baseline: 5.33x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Loma Linda University Children's Hospital is $76. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 5.33x the Medicare baseline. Located in 11234 Anderson Street Suite A, Loma Linda, CA.

Cash / Self-Pay

$63

Average discount available for prompt cash payment at this facility.

Insurance Median

$76

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: $63 (441%)

Insurance Median: $76 (533%)

Cash: $63 (441% of Medicare)

Ins. Median: $76 (533% 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 533% of the Medicare baseline (a markup of 433%). 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
UnitedHealthcare	$12	84%
Alpha Care Medical Group	$14 - $21	98%
Dignity Health	$14 - $21	98%
Epic Health Plan	$14 - $128	98%
Inland Empire Health Plan (Iehp)	$14 - $21	98%
Kaiser Foundation Hospitals	$14 - $213	98%
Upland Medical Group	$14	98%
Vantage Medical Group	$14 - $21	98%
Molina Healthcare Of Ca	$18 - $19	126%
Heritage Provider Network	$23	161%
Adventist Health	$25 - $64	175%
Lluh Dept Of Risk Management	$30 - $77	210%
Blue Shield Of California	$56 - $94	392%
Global Benefits Group	$76 - $191	533%
Temecula Valley Physicians Medical Group	$76 - $85	533%
Trivalley Medical Group	$76 - $85	533%
Cigna	$81 - $104	568%
Networks By Design	$82 - $207	575%
Aetna	$83 - $93	582%
Multiplan	$101 - $255	708%
Galaxy Health	$107 - $271	750%
Prime Health Services	$107 - $271	750%
Blue Cross Blue Shield	$136	953%

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 $63.
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 Loma Linda University Children's 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.