CMS Price Transparency Data

Hepatitis C antibody test

Facility: Adventist Health Tulare

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $20
Cash Discount Price: $29
vs. Medicare Baseline: 1.40x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Adventist Health Tulare is $20. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $29. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 1.40x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$29

Average discount available for prompt cash payment at this facility.

Insurance Median

$20

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: $29 (203%)

Insurance Median: $20 (140%)

Cash: $29 (203% of Medicare)

Ins. Median: $20 (140% 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	$4 - $141	28%
Blue Shield Epn	$4 - $93	28%
Blue Shield-All Other Plans	$5 - $128	35%
Cigna	$6 - $136	42%
Western Growers - All Plans	$6 - $135	42%
Hs Interplan-All Plans	$8 - $196	56%
Network By Design-All Plans	$8 - $190	56%
UnitedHealthcare	$9 - $212	63%
Multiplan - All Plans	$11 - $249	77%
Ccipa Medi-Cal - All Plans	$13 - $21	91%
Dignity Mcal Op Only	$13 - $18	91%
Healthnet Medi-Cal	$13 - $21	91%
Independence Op Only - All Plans	$13 - $18	91%
Medi-Cal	$13 - $16	91%
Blue Shield Mcare	$14	98%
Dignity Mcr Op Only - All Other Plans	$14	98%
Fhcn Pace Mcr Adv - All Plans	$14	98%
Medicare (plans)	$14	98%
Prime Health - All Plans	$14	98%
Tricare	$14	98%
Prison Hlthcre - All Plans	$18	126%
Cal Forensic Med Grp - All Plans	$19	133%
Bright Health - All Plans	$21	147%
Ah Employee Health Plan - All Plans	$26	182%
Incentive Hlth - All Plans	$26	182%
Healthnet Hmo/Ppo - All Other Plans	$38	266%
Aetna	$124	869%

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 $29.
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 Tulare 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.