CMS Price Transparency Data

Hepatitis C antibody test

Facility: Sterling Regional Medcenter

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $79
Cash Discount Price: $39
vs. Medicare Baseline: 5.54x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Sterling Regional Medcenter is $79. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $39. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 5.54x the Medicare baseline. Located in 615 Fairhurst St, Sterling, CO.

Cash / Self-Pay

$39

Average discount available for prompt cash payment at this facility.

Insurance Median

$79

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: $39 (273%)

Insurance Median: $79 (554%)

Cash: $39 (273% of Medicare)

Ins. Median: $79 (554% 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 554% of the Medicare baseline (a markup of 454%). 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
Clear Spring Health	$14	98%
UnitedHealthcare	$14 - $90	98%
Humana	$15	105%
Longevity	$15	105%
Devoted Health Services	$16	112%
Pinnacol Assurance Workers Comp	$22 - $46	154%
Aetna	$26 - $88	182%
Banner Health	$29	203%
Blue Cross Blue Shield	$29 - $136	203%
Healthspring Life & Health Insurance Company, Inc.	$29	203%
Medica	$29 - $79	203%
Medicare (plans)	$29	203%
Assist Health Group	$35	245%
Denver Health Medical Plan	$58	406%
Apostrophe, Inc.	$86	603%
First Choice Health Network	$86	603%
First Choice Of The Midwest	$90	631%
Hue Health, Inc	$90	631%
Rocky Mountain Health Plans	$90	631%
Multiplan	$92	645%

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 $39.
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 Sterling Regional Medcenter 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.