CMS Price Transparency Data

Hepatitis C antibody test

Facility: Cook Childrens Medical Center

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $87
Cash Discount Price: $183
vs. Medicare Baseline: 6.10x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Cook Childrens Medical Center is $87. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $183. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 6.10x the Medicare baseline. Located in 801 Seventh Avenue, Fort Worth, TX.

Cash / Self-Pay

$183

Average discount available for prompt cash payment at this facility.

Insurance Median

$87

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: $183 (1282%)

Insurance Median: $87 (610%)

Cash: $183 (1282% of Medicare)

Ins. Median: $87 (610% 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 610% of the Medicare baseline (a markup of 510%). 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
Health Plan W. Uhrip	$12 - $143	84%
Aetna	$14 - $320	98%
Beacon	$14 - $90	98%
El Paso Health First	$14	98%
Health Plan W/O Uhrip	$14 - $90	98%
Tx Children Health	$14	98%
Blue Cross Blue Shield	$15 - $339	105%
Superior Health	$15	105%
Wellpoint	$15	105%
Firstcare	$16 - $301	112%
Molina	$16	112%
Rightcare	$16 - $126	112%
United Community	$16	112%
UnitedHealthcare	$49 - $320	343%
S&W Health	$94 - $316	659%
Cigna	$95 - $320	666%
Healthscope	$95 - $320	666%
Imagine Health	$95 - $320	666%
Humana	$97 - $331	680%
Multiplan	$97 - $327	680%
First Health	$98 - $331	687%
Galaxy Health	$100 - $339	701%
Healthsmart	$100 - $339	701%
Usamco	$103 - $346	722%

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 $183.
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 Cook Childrens Medical Center 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.