CMS Price Transparency Data

Hepatitis C antibody test

Facility: Valley West Community Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $115
Cash Discount Price: $117
vs. Medicare Baseline: 8.06x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Valley West Community Hospital is $115. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $117. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 8.06x the Medicare baseline. Located in 11 East Pleasant Avenue, Sandwich, IL.

Cash / Self-Pay

$117

Average discount available for prompt cash payment at this facility.

Insurance Median

$115

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: $117 (820%)

Insurance Median: $115 (806%)

Cash: $117 (820% of Medicare)

Ins. Median: $115 (806% 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 806% of the Medicare baseline (a markup of 706%). 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	$30 - $208	210%
Global Excel [1712]	$30 - $48	210%
Humana	$30 - $48	210%
Aetna	$41 - $176	287%
Health'S Finest Network [126]	$72 - $216	505%
The Alliance [1703]	$87 - $138	610%
Choicecare [177]	$108 - $171	757%
Healthlink [125]	$120 - $190	841%
Multiplan/Phcs [142]	$128 - $254	897%
First Health Plan [6034]	$160 - $254	1121%
UnitedHealthcare	$160 - $254	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 $117.
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 Valley West 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.