CMS Price Transparency Data

Hepatitis C antibody test

Facility: Carilion Giles Community Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $72
Cash Discount Price: $41
vs. Medicare Baseline: 5.05x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Carilion Giles Community Hospital is $72. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 5.05x the Medicare baseline. Located in 159 Hartley Way, Pearisburg, VA.

Cash / Self-Pay

$41

Average discount available for prompt cash payment at this facility.

Insurance Median

$72

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: $41 (287%)

Insurance Median: $72 (505%)

Cash: $41 (287% of Medicare)

Ins. Median: $72 (505% 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 505% of the Medicare baseline (a markup of 405%). 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
Blue Cross Blue Shield	$15	105%
Sentara Health Plan	$15 - $72	105%
Abh Of Va (Formerly Coventry)	$16	112%
Abh Of Wva (Formerly Coventry)	$16	112%
Humana	$16	112%
UnitedHealthcare	$16 - $95	112%
Aetna	$59 - $77	413%
Gateway - Tier 3	$64	448%
Vhn - Ultra	$72	505%
Cigna	$78 - $84	547%
Connecticare	$81	568%
Vhn - Plus	$89	624%
Gateway - Tier 2	$93	652%
Vhn	$93	652%
Vhn - Link	$104	729%
Gateway - Tier 1	$110	771%
Vhn - Secondary Payors	$110	771%

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 $41.
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 Carilion Giles Community 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.