CMS Price Transparency Data

Hepatitis C antibody test

Facility: UCSF Health St. Mary's Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $34
Cash Discount Price: $455
vs. Medicare Baseline: 2.38x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at UCSF Health St. Mary's Hospital is $34. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $455. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 2.38x the Medicare baseline. Located in 450 Stanyan St, San Francisco, CA.

Cash / Self-Pay

$455

Average discount available for prompt cash payment at this facility.

Insurance Median

$34

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: $455 (3189%)

Insurance Median: $34 (238%)

Cash: $455 (3189% of Medicare)

Ins. Median: $34 (238% 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 238% of the Medicare baseline (a markup of 138%). 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
Aetna	$14 - $80	98%
Blue Cross Blue Shield	$14 - $353	98%
Blue Shield Ca	$14 - $388	98%
Brown Toland	$14	98%
Chinese Community	$14 - $311	98%
Connected Care	$14	98%
Health Net	$14 - $26	98%
Health Plan San Mateo	$14 - $18	98%
Humana	$14	98%
Kaiser	$14 - $364	98%
Mhn	$14	98%
United	$14 - $17	98%
California Health & Wellness	$18	126%
Partnership Health Plan	$18	126%
Sfhp	$18	126%
Kentfield	$41	287%
Oscar	$47	329%
Cigna	$62 - $66	434%
Magellan	$259 - $287	1815%
Healthsmart	$302 - $335	2116%
Multiplan	$358 - $398	2509%
Us Behavioral Health	$431 - $479	3020%

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 $455.
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 UCSF Health St. Mary'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.