CMS Price Transparency Data

Hepatitis C antibody test

Facility: UT Health East Texas Carthage Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $440
Cash Discount Price: $109
vs. Medicare Baseline: 30.83x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at UT Health East Texas Carthage Hospital is $440. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $109. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 30.83x the Medicare baseline. Located in 409 Cottage Rd, Carthage, TX.

Cash / Self-Pay

$109

Average discount available for prompt cash payment at this facility.

Insurance Median

$440

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: $109 (764%)

Insurance Median: $440 (3083%)

Cash: $109 (764% of Medicare)

Ins. Median: $440 (3083% 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 3083% of the Medicare baseline (a markup of 2983%). 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
Amerigroup Commercial [5055]	$272	1906%
Black Lung [6055]	$272	1906%
Healthcare Highways [2210]	$272	1906%
Healthscope Benefits [2290]	$272	1906%
Lucent Health [6000]	$272	1906%
Medicaid / KanCare	$272	1906%
Parkland Community Health Plan [6015]	$272	1906%
Web Tpa [2115]	$272 - $665	1906%
Cigna	$607 - $685	4254%
Aetna	$665	4660%
Mailhandlers [1595]	$665	4660%
Group Pension Admin [1450]	$685	4800%
Humana	$685	4800%
Phcs [1780]	$685	4800%
Tml [1980]	$685	4800%

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 $109.
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 UT Health East Texas Carthage 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.