CMS Price Transparency Data

Hepatitis C antibody test

Facility: Atrium Health Cleveland

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $175
Cash Discount Price: $175
vs. Medicare Baseline: 12.26x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Atrium Health Cleveland is $175. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $175. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 12.26x the Medicare baseline. Located in 201 E Grover St, Shelby, NC.

Cash / Self-Pay

$175

Average discount available for prompt cash payment at this facility.

Insurance Median

$175

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: $175 (1226%)

Insurance Median: $175 (1226%)

Cash: $175 (1226% of Medicare)

Ins. Median: $175 (1226% 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 1226% of the Medicare baseline (a markup of 1126%). 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
Aetna	$15 - $269	105%
Cigna	$15 - $279	105%
Humana	$15	105%
UnitedHealthcare	$15 - $186	105%
Alliance	$18 - $58	126%
Amerihealth Caritas	$18 - $26	126%
Carolina Complete Health	$18 - $26	126%
Healthy Blue	$18 - $26	126%
Partners	$18 - $26	126%
Trillium	$18 - $26	126%
Vaya	$18 - $26	126%
Wellcare	$18 - $26	126%
Blue Cross Blue Shield	$109 - $143	764%
Ambetter / Centene	$112 - $127	785%
Employers Health Network	$154 - $185	1079%
Physician Reach Out	$175	1226%
Medcost	$195 - $231	1367%
Magellan	$209	1465%
Gmmi	$227	1591%
Quik Trip	$227	1591%
Carolina Behavioral Health	$251 - $279	1759%
Healthgram	$279	1955%
Choicecare	$286	2004%
First Health	$297	2081%
Lifesynch Community Choice Care	$297	2081%
Private Health Care Systems	$314	2200%
Beechstreet	$321	2249%
Multiplan	$332	2327%

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 $175.
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 Atrium Health Cleveland 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.