CMS Price Transparency Data

Hepatitis C antibody test

Facility: Prisma Health Tuomey Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $20
  • Cash Discount Price: $132
  • vs. Medicare Baseline: 1.40x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at Prisma Health Tuomey Hospital is $20. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $132. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 1.40x the Medicare baseline. Located in 129 N Washington St, Sumter, SC.
Cash / Self-Pay
$132

Average discount available for prompt cash payment at this facility.

Insurance Median
$20

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: $132 (925%)
Insurance Median: $20 (140%)
Cash: $132 (925% of Medicare)
Ins. Median: $20 (140% 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.

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
Golden Rule Insurance Company [2991] $13 91%
Oxford Health Plans [2992] $13 91%
Tricare $13 91%
UnitedHealthcare $13 - $18 91%
Zzumr-Salt Lake City Ut [3169] $13 91%
Blue Cross Blue Shield $14 - $60 98%
Cigna $14 - $81 98%
Covid19 Hrsa Uninsured Testing & Treatment Fund [904] $14 98%
Humana $14 - $152 98%
Medicare (plans) $14 - $15 98%
Triwest Healthcare Alliance Vcp [902] $14 98%
Va Community Care Network-Vaccn [903] $14 98%
Aetna $15 - $160 105%
Healthy Conn Prime-First Choice Vip Care [5300] $15 105%
Healthy Conn Prime-Molina Healthcare [5330] $15 105%
Healthy Conn Prime-Wellcare Prime By Atc [5310] $15 105%
Medicaid / KanCare $18 - $19 126%
Workers Comp [600] $20 140%
Ambetter / Centene $26 182%
Bluechoice [810] $34 - $42 238%
Planned Administrators [820] $42 294%
Prisma Health Seniorcare Pace - Midlands [5400] $47 329%
Prisma Health Seniorcare Pace-Upstate [5200] $47 329%
Scdc-Sc Dept Of Corrections [7232] $60 420%
Promise Health Plan Contracted [2401] $71 - $122 498%
Orangeburg Senior Helping Center Pace [5401] $81 568%
Bob Jones Univ-Pai [821] $122 855%
Meritain Health Contracted [2200] $130 - $160 911%
Preferred Administrators Contracted [2839] $142 995%
Medcost [2940] $150 - $168 1051%
Atlantic Packaging Contracted [4833] $152 1065%
Aps Healthcare System [2981] $162 1135%
Multiplan/Phcs Contracted [2950] $181 1268%
Vsp Vision Care [2986] $183 1282%
First Health Contracted [2952] $189 1324%
Furman Int/Allen University Student [2951] $189 1324%
Quiktrip-First Health [3067] $189 1324%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 129 N Washington St, Sumter, SC 29150
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals