CMS Price Transparency Data

Hepatitis C antibody test

Facility: Shriners Hospitals for Children Northern Calif

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $16
Cash Discount Price: $134
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Shriners Hospitals for Children Northern Calif is $16. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $134. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 1.12x the Medicare baseline. Located in 2425 Stockton Boulevard, Sacramento, CA.

Cash / Self-Pay

$134

Average discount available for prompt cash payment at this facility.

Insurance Median

$16

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: $134 (939%)

Insurance Median: $16 (112%)

Cash: $134 (939% of Medicare)

Ins. Median: $16 (112% 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
Aetna	$6 - $18	42%
Blue Cross Blue Shield	$6 - $21	42%
Amerigroup Nv	$9	63%
Ambetter / Centene	$10 - $26	70%
Caresource Of Ga	$10	70%
Health Plan Of Nv	$10	70%
Wellcare Of Ga	$10	70%
Amerigroup Tx	$13	91%
Soonercare	$13	91%
Coventry Cares Ky	$14	98%
Humana	$14	98%
Medicaid / KanCare	$14	98%
Molina Healthcare Of Ky	$14	98%
Molina Healthcare Of Ms	$14	98%
Northbay Healthcare	$14	98%
UnitedHealthcare	$14 - $20	98%
Cigna	$15	105%
Amerihealth Caritas Nc	$16 - $26	112%
Amerihealth Caritas Sc	$16	112%
Caresource Of Oh	$16	112%
Health Net Of Ca	$16	112%
Providence Health Plan	$16	112%
Sutter Medical Foundation	$16	112%
Central California Alliance For Health	$18	126%
Health Plan Of San Joaquin	$18	126%
Healthchoice Of Oklahoma	$18	126%
Kaiser Permanente	$18 - $100	126%
Molina Healthcare Of Ca	$18	126%
Partnership Healthplan Of Ca	$18	126%
Gateway Health Plan	$19	133%
Sana Benefits	$20	140%
Dignity Health	$536	3756%

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 $134.
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 Shriners Hospitals for Children Northern Calif 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.