CMS Price Transparency Data

Hepatitis C antibody test

Facility: Good Samaritan Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $21
Cash Discount Price: $49
vs. Medicare Baseline: 1.47x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Good Samaritan Hospital is $21. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $49. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 1.47x the Medicare baseline. Located in 375 Dixmyth Avenue, Cincinnati, OH.

Cash / Self-Pay

$49

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: $49 (343%)

Insurance Median: $21 (147%)

Cash: $49 (343% 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
Cigna	$8 - $92	56%
Blue Cross Blue Shield	$12 - $18	84%
Custom Design Benefits	$14 - $37	98%
Buckeye	$15 - $21	105%
Medical Mutual Of Ohio	$15	105%
UnitedHealthcare	$17	119%
Oscar	$21	147%
Aetna	$31 - $32	217%
Imagine Health	$34	238%
Medben	$39 - $41	273%

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 $49.
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 Good Samaritan 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.