CMS Price Transparency Data

Hepatitis C antibody test

Facility: Palos Community Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $157
Cash Discount Price: $145
vs. Medicare Baseline: 11.00x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Palos Community Hospital is $157. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $145. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 11.00x the Medicare baseline. Located in 12251 South 80Th Avenue, Palos Heights, IL.

Cash / Self-Pay

$145

Average discount available for prompt cash payment at this facility.

Insurance Median

$157

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: $145 (1016%)

Insurance Median: $157 (1100%)

Cash: $145 (1016% of Medicare)

Ins. Median: $157 (1100% 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 1100% of the Medicare baseline (a markup of 1000%). 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
Blue Cross Blue Shield	$26 - $256	182%
Aetna	$34 - $256	238%
Carelon Behavioral Health [159]	$80 - $128	561%
Healthlink [125]	$80 - $256	561%
Magellan Behavioral Hlth [136]	$96 - $154	673%
Multiplan/Phcs [142]	$112 - $256	785%
Compsych [112]	$120 - $192	841%
First Health Plan [6034]	$120 - $192	841%
Beechstreet [176]	$128 - $205	897%
Cigna	$128 - $256	897%
Health'S Finest Network [126]	$136 - $218	953%
Galaxy Health Network [220]	$160 - $256	1121%
Global Excel [1712]	$160 - $256	1121%
Health Alliance [181]	$160 - $256	1121%
UnitedHealthcare	$160 - $256	1121%

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 $145.
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 Palos Community 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.