CMS Price Transparency Data

Hepatitis C antibody test

Facility: T J Samson Community Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $35
Cash Discount Price: $140
vs. Medicare Baseline: 2.45x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at T J Samson Community Hospital is $35. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $140. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 2.45x the Medicare baseline. Located in 1301 North Race Street, Glasgow, KY.

Cash / Self-Pay

$140

Average discount available for prompt cash payment at this facility.

Insurance Median

$35

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: $140 (981%)

Insurance Median: $35 (245%)

Cash: $140 (981% of Medicare)

Ins. Median: $35 (245% 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 245% of the Medicare baseline (a markup of 145%). 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
Caresource - All Plans	$5 - $36	35%
Blue Cross Blue Shield	$12 - $217	84%
Humana	$14 - $255	98%
Signature Health - All Plans	$14	98%
Wellcare Mcaid	$14	98%
Wellcare Mcr Adv - All Other Plans	$14	98%
Devoted Mcr Adv - All Plans	$15	105%
Molina Mcr Adv	$15	105%
UnitedHealthcare	$18 - $128	126%
Molina Marketplace - All Other Plans	$21	147%
Center Care Select - All Plans	$31 - $217	217%
First Health - All Plans	$34 - $242	238%
Phcs/Multiplan - All Plans	$34 - $240	238%
Aetna	$36 - $255	252%
Molina Mcaid	$37 - $263	259%

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 $140.
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 T J Samson 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.