CMS Price Transparency Data

Hepatitis C antibody test

Facility: Gunnison Valley Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $124
Cash Discount Price: $132
vs. Medicare Baseline: 8.69x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Gunnison Valley Hospital is $124. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $132. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 8.69x the Medicare baseline. Located in 711 N Taylor St, Gunnison, CO.

Cash / Self-Pay

$132

Average discount available for prompt cash payment at this facility.

Insurance Median

$124

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: $132 (925%)

Insurance Median: $124 (869%)

Cash: $132 (925% of Medicare)

Ins. Median: $124 (869% 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 869% of the Medicare baseline (a markup of 769%). 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
Medicaid / KanCare	$13	91%
Medicare (plans)	$76	533%
Gunnison County Coroner Op Only	$80	561%
Gunnison County Sheriff Op & Profee Only	$80	561%
Occumed Op Only-All Plans	$87	610%
Ebms Hdhp	$93	652%
Tetwp Op & Profee Only-All Plans	$93	652%
U Of Co Transplant-All Plans	$93	652%
Ebms Ppo Plan-All Other Plans	$109	764%
Gunnison County Employees-All Other Plans	$124	869%
Scottish Rites-All Plans	$124	869%
Elap Employers-All Plans	$132	925%
Blue Cross Blue Shield	$136	953%
Apostrophe-All Plans	$140	981%
Multiplan-All Plans	$145	1016%
Rocky Mountain Health-All Plans	$148	1037%
UnitedHealthcare	$148	1037%
Aetna	$149	1044%
Cofinity-All Plans	$149	1044%
Cigna	$152	1065%

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 $132.
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 Gunnison Valley 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.