CMS Price Transparency Data

Hepatitis C antibody test

Facility: Pulaski Memorial Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $58
Cash Discount Price: $90
vs. Medicare Baseline: 4.06x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Pulaski Memorial Hospital is $58. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 4.06x the Medicare baseline. Located in 616 E 13Th St, Winamac, IN.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$58

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: $90 (631%)

Insurance Median: $58 (406%)

Cash: $90 (631% of Medicare)

Ins. Median: $58 (406% 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 406% of the Medicare baseline (a markup of 306%). 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	$14 - $127	98%
Caresource Mcaid Hhw	$14	98%
Cenpatico Mcaid Hhw - All Other Plans	$14	98%
Mdwise Mcaid Hcc	$14	98%
Mdwise Mcaid Hhw	$14	98%
Mhs Mcaid Hhw/Hcc	$14	98%
UnitedHealthcare	$14 - $151	98%
Ambetter / Centene	$20 - $59	140%
Caresource Mcaid Hip	$20 - $59	140%
Caresource Mcare Hmo	$20 - $59	140%
Cenpatico Mcaid Hip	$20 - $59	140%
Mdwise Mcaid Hip - All Other Plans	$20 - $59	140%
Mhs Mcaid Hip	$20 - $59	140%
Humana	$21 - $153	147%
Mhs Mcare Allwell	$21 - $60	147%
Aetna	$24 - $69	168%
Caresource Exch Hmo Hix - All Other Plans	$25 - $74	175%
Sagamore Rose Acre	$49 - $142	343%
Sagamore - All Other Plans	$50 - $144	350%
Encore Ppo - All Other Plans	$56 - $162	392%
Community Health Alliance - All Plans	$58 - $170	406%
Encore Workers Comp	$59 - $172	413%
Multiplan - All Plans	$59 - $172	413%
Cigna	$62 - $181	434%

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 $90.
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 Pulaski 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.