CMS Price Transparency Data

Hepatitis C antibody test

Facility: Elkhart General Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $89
Cash Discount Price: $97
vs. Medicare Baseline: 6.24x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Elkhart General Hospital is $89. 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 6.24x the Medicare baseline. Located in 600 E Blvd, Elkhart, IN.

Cash / Self-Pay

$97

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $89 (624%)

Cash: $97 (680% of Medicare)

Ins. Median: $89 (624% 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 624% of the Medicare baseline (a markup of 524%). 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
Mclaren (Mi	$8	56%
UnitedHealthcare	$8 - $100	56%
Blue Cross Blue Shield	$12 - $37	84%
Aetna	$14 - $101	98%
Caresource	$14 - $194	98%
Humana	$14 - $104	98%
Mdwise	$14 - $194	98%
Mhs	$14 - $194	98%
Pace	$14	98%
Devoted Healthcare	$15 - $30	105%
Plain Church	$21 - $119	147%
Cha	$89 - $116	624%
Immergrun	$89 - $119	624%
Php	$97 - $104	680%
Cigna	$107 - $113	750%
Multiplan	$107	750%
Signature	$109	764%
Encore	$110	771%
Heartland	$149	1044%

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 Elkhart General 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.