CMS Price Transparency Data

Hepatitis C antibody test

Facility: Rochelle Community Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $118
Cash Discount Price: $152
vs. Medicare Baseline: 8.27x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Rochelle Community Hospital is $118. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $152. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 8.27x the Medicare baseline. Located in 900 N 2Nd St, Rochelle, IL.

Cash / Self-Pay

$152

Average discount available for prompt cash payment at this facility.

Insurance Median

$118

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: $152 (1065%)

Insurance Median: $118 (827%)

Cash: $152 (1065% of Medicare)

Ins. Median: $118 (827% 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 827% of the Medicare baseline (a markup of 727%). 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
Aetna	$16 - $55	112%
Blue Cross Blue Shield	$16 - $156	112%
Medicaid / KanCare	$16	112%
The Alliance-All Plans	$21 - $22	147%
Health Alliance Mcr Adv	$52 - $55	364%
Humana	$52 - $125	364%
UnitedHealthcare	$52 - $140	364%
Va Ccn - All Plans	$52 - $55	364%
Wellcare Mcr Adv - All Plans	$53 - $56	371%
Cigna	$111 - $117	778%
Osf Dan Ppo - All Plans	$111 - $117	778%
Beech Street-All Plans	$118 - $125	827%
First Health - All Plans	$118 - $125	827%
Health Alliance-All Other Plans	$118 - $125	827%
Ecoh-All Plans	$126 - $133	883%
Hfn-All Plans	$126 - $133	883%
Quartz Health Solutions-All Plans	$130 - $137	911%
Multiplan-All Plans	$139 - $147	974%

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 $152.
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 Rochelle 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.