CMS Price Transparency Data

Hepatitis C antibody test

Facility: Tops Surgical Specialty Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $18
Cash Discount Price: $168
vs. Medicare Baseline: 1.26x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Tops Surgical Specialty Hospital is $18. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $168. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 1.26x the Medicare baseline. Located in 17080 Red Oak Drive, Houston, TX.

Cash / Self-Pay

$168

Average discount available for prompt cash payment at this facility.

Insurance Median

$18

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: $168 (1177%)

Insurance Median: $18 (126%)

Cash: $168 (1177% of Medicare)

Ins. Median: $18 (126% 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
UnitedHealthcare	$12 - $17	84%
Blue Cross Blue Shield	$15 - $23	105%
Oscar Health Plan	$16	112%
Cigna	$18 - $19	126%
Ambetter / Centene	$20 - $4,848	140%
Health Net	$21	147%
Aetna	$79 - $213	554%

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 $168.
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 Tops Surgical Specialty 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.