CMS Price Transparency Data

Hepatitis C antibody test

Facility: The Heart Hospital Baylor Denton

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $63
Cash Discount Price: $142
vs. Medicare Baseline: 4.41x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at The Heart Hospital Baylor Denton is $63. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $142. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 4.41x the Medicare baseline. Located in 2801 South Mayhill Road, Denton, TX.

Cash / Self-Pay

$142

Average discount available for prompt cash payment at this facility.

Insurance Median

$63

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: $142 (995%)

Insurance Median: $63 (441%)

Cash: $142 (995% of Medicare)

Ins. Median: $63 (441% 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 441% of the Medicare baseline (a markup of 341%). 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
UnitedHealthcare	$10 - $16	70%
Baylor Scott & White Health Plan	$14 - $137	98%
Humana	$14 - $165	98%
Triwest	$14	98%
American Health Plan	$15	105%
Blue Cross Blue Shield	$15 - $70	105%
Corvel	$15	105%
Healthspring	$15	105%
Prime Health Services	$15	105%
Procare Advantage	$15	105%
Superior Health Plan	$15 - $26	105%
Ambetter / Centene	$30	210%
Cigna	$116 - $137	813%
Aetna	$130	911%
Employers Health Network	$130	911%
Quiktrip	$130	911%
University Of Mary Hardin-Baylor	$137	960%
Imagine Health	$148	1037%
Curative	$153	1072%
First Health	$165	1156%
Healthsmart	$165 - $177	1156%
Private Health Care System	$177	1240%

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 $142.
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 The Heart Hospital Baylor Denton 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.