CMS Price Transparency Data

Hepatitis C antibody test

Facility: Kapiolani Medical Center for Women & Children

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $86
Cash Discount Price: $97
vs. Medicare Baseline: 6.03x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Kapiolani Medical Center for Women & Children is $86. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $97. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 6.03x the Medicare baseline. Located in 1319 Punahou Street, Honolulu, HI.

Cash / Self-Pay

$97

Average discount available for prompt cash payment at this facility.

Insurance Median

$86

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: $97 (680%)

Insurance Median: $86 (603%)

Cash: $97 (680% of Medicare)

Ins. Median: $86 (603% 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 603% of the Medicare baseline (a markup of 503%). 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
Alohacare	$14 - $16	98%
Hmsa	$14 - $31	98%
Kaiser	$14 - $158	98%
Mdx	$14 - $16	98%
Devoted	$15	105%
Ohana	$17 - $53	119%
Hcha	$29	203%
UnitedHealthcare	$30	210%
Pac Admin	$32	224%
Uha	$33 - $90	231%
Hwmg/Hmaa	$36	252%
Mimoh	$69 - $135	484%
Calvos	$74 - $135	519%
Multiplan	$78 - $153	547%
Verdegard	$78 - $144	547%
Mccp	$83 - $153	582%
Coventry	$88 - $162	617%

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 $97.
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 Kapiolani Medical Center for Women & Children 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.