CMS Price Transparency Data

Hepatitis C antibody test

Facility: Rush Memorial Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $146
Cash Discount Price: $159
vs. Medicare Baseline: 10.23x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Rush Memorial Hospital is $146. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $159. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 10.23x the Medicare baseline. Located in 1300 N Main St, Rushville, IN.

Cash / Self-Pay

$159

Average discount available for prompt cash payment at this facility.

Insurance Median

$146

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: $159 (1114%)

Insurance Median: $146 (1023%)

Cash: $159 (1114% of Medicare)

Ins. Median: $146 (1023% 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 1023% of the Medicare baseline (a markup of 923%). 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
Health Net	$61 - $64	427%
Caresource Mcr Adv	$64 - $67	448%
My True Advantage - All Plans	$64 - $67	448%
UnitedHealthcare	$64 - $174	448%
Aetna	$65 - $200	456%
Humana	$65 - $200	456%
Blue Cross Blue Shield	$66 - $159	463%
Today'S Option Mcr Adv-All Plans	$66 - $69	463%
Viant Beech St Mcr Adv	$66 - $69	463%
Caresource Marketplace-All Other Plans	$103 - $108	722%
Cigna	$166 - $174	1163%
Phcs-All Plans	$166 - $174	1163%
Consumers Life Ins-All Plans	$186 - $196	1303%
Coventry/First Health-All Plans	$186 - $196	1303%
Sagamore-All Plans	$190 - $200	1331%
Siho-All Plans	$190 - $200	1331%
Multiplan-All Plans	$192 - $202	1345%
Community Health Alliance-All Plans	$194 - $204	1359%
Encore Health Services-All Plans	$203 - $213	1423%

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 $159.
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 Rush Memorial 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.