CMS Price Transparency Data

Hepatitis C antibody test

Facility: Piedmont Walton Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $234
Cash Discount Price: $121
vs. Medicare Baseline: 16.40x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Piedmont Walton Hospital is $234. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $121. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 16.40x the Medicare baseline. Located in 2151 W Spring Street, Monroe, GA.

Cash / Self-Pay

$121

Average discount available for prompt cash payment at this facility.

Insurance Median

$234

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: $121 (848%)

Insurance Median: $234 (1640%)

Cash: $121 (848% of Medicare)

Ins. Median: $234 (1640% 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 1640% of the Medicare baseline (a markup of 1540%). 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	$12 - $20	84%
UnitedHealthcare	$13	91%
Alliant Health Plans Of Georgia [10952]	$51	357%
Blue Cross Blue Shield	$187	1310%
First Health [10303]	$281	1969%
Aetna	$286	2004%
Novanet [10819]	$301	2109%
Multiplan [10600]	$321	2249%
Phcs [10601]	$321	2249%
Kaiser [10500]	$342	2397%
Beechstreet [10800]	$362	2537%

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 $121.
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 Piedmont Walton 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.