CMS Price Transparency Data

Hepatitis C antibody test

Facility: El Paso Children's Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $50
Cash Discount Price: $21
vs. Medicare Baseline: 3.50x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at El Paso Children's Hospital is $50. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 3.50x the Medicare baseline. Located in 4845 Alameda Avenue, El Paso, TX.

Cash / Self-Pay

$21

Average discount available for prompt cash payment at this facility.

Insurance Median

$50

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: $21 (147%)

Insurance Median: $50 (350%)

Cash: $21 (147% of Medicare)

Ins. Median: $50 (350% 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 350% of the Medicare baseline (a markup of 250%). 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 Tx	$14	98%
Point Comfort Underwriters	$14	98%
Superior	$14	98%
Uh Military Va	$14	98%
Blue Cross Blue Shield	$15 - $105	105%
El Paso First Health Plan	$15	105%
Health Net Fed Svcs	$15	105%
El Paso Health Plans	$16	112%
Molina Tx	$16	112%
Western Sky	$35 - $74	245%
Molina Nm	$45	315%
UnitedHealthcare	$47 - $101	329%
Aetna	$48 - $112	336%
Cigna	$52 - $110	364%
Coventry Health Care	$53 - $112	371%
Fortified Provider Network	$53 - $112	371%
Multiplan	$53 - $112	371%

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 $21.
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 El Paso Children's 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.