CMS Price Transparency Data

Hepatitis C antibody test

Facility: Monroe Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $21
Cash Discount Price: $14
vs. Medicare Baseline: 1.47x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Monroe Hospital is $21. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $14. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 1.47x the Medicare baseline. Located in 4011 S Monroe Medical Park Blvd, Bloomington, IN.

Cash / Self-Pay

$14

Average discount available for prompt cash payment at this facility.

Insurance Median

$21

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: $14 (98%)

Insurance Median: $21 (147%)

Cash: $14 (98% of Medicare)

Ins. Median: $21 (147% 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.

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	$14	98%
Blue Cross Blue Shield	$14 - $26	98%
Care Source	$14 - $21	98%
Medicaid / KanCare	$14	98%
Medicare (plans)	$14	98%
Monroe Medical Group And Managed Health Services	$14 - $19	98%
Tricare	$14	98%
UnitedHealthcare	$14	98%
Usa Senior Care Network	$14	98%
Worthington Christian Fellowship	$14	98%
Provider Partners Health Plan	$16	112%
Employer Direct Healthcare	$20	140%
Americas Choice Provider Network Acpn	$25 - $28	175%
Corvel Workers Compensation	$25	175%
Encore Health Network Workers Compensation	$25 - $28	175%
Multiplan	$25 - $28	175%
Prime Health Services	$25 - $28	175%
Provider Network Of America	$25 - $29	175%
Provider Select	$25 - $28	175%
Three Rivers	$25 - $28	175%
Workers Compensation	$25 - $29	175%
Zelis Healthcare Fka Stratose	$25 - $27	175%

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 $14.
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 Monroe 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.