CMS Price Transparency Data

Hepatitis C antibody test

Facility: Saint Mary's Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $29
  • Cash Discount Price: $54
  • vs. Medicare Baseline: 2.03x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at Saint Mary's Hospital is $29. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $54. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 2.03x the Medicare baseline. Located in 56 Franklin Street, Waterbury, CT.
Cash / Self-Pay
$54

Average discount available for prompt cash payment at this facility.

Insurance Median
$29

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: $54 (378%)
Insurance Median: $29 (203%)
Cash: $54 (378% of Medicare)
Ins. Median: $29 (203% 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 203% of the Medicare baseline (a markup of 103%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Connecticut Dept of Correction $11 - $38 77%
Blue Cross Blue Shield $13 - $16 91%
Aetna $14 - $26 98%
Cca Senior Care Options $14 98%
Cigna $14 - $122 98%
Geha $14 98%
Harvard Pilgrim Healthcare $14 98%
Medicare (plans) $14 - $15 98%
UnitedHealthcare $14 - $153 98%
Bcn Domestic $16 112%
Blue Benefit Administrators of Massachusetts $16 112%
Blue Care Network $16 112%
Blue Distinction Transplant $16 112%
Blue Shield - Ca $16 112%
Blue Shield - Id (Regence) $16 112%
Blue Shield - Ny Highmark Northeastern $16 112%
Blue Shield - Ny Highmark Western $16 112%
Blue Shield - PA (Highmark) $16 112%
Blue Shield - Wa (Regence) $16 112%
Connecticare $16 112%
Health Choices $16 112%
Kaiser Domestic $16 112%
Pre-Employment $16 112%
Unicare $16 112%
Wc Domestic $16 112%
Wellpoint $16 112%
Centivo $18 126%
Carelon Behavioral Health $22 - $76 154%
Health New England $23 - $81 161%
1199 National Benefit Fund $26 182%
Allied Benefit Systems $26 182%
Gravie Admin Services $26 182%
Hap $26 182%
Luminare Health $26 182%
Meritain $26 182%
Nippon Life Ins $26 182%
Webtpa $26 182%
Allegiance $29 203%
Health Partners $29 203%
Magnacare $29 203%
Claimdoc $30 210%
Diversified Administrators $30 210%
Innovative Health Plan II $30 210%
Allied National Global Care $33 - $118 231%
Asrm - Reliance Standard Life Insurance $33 - $118 231%
Christian Care Ministry $33 - $118 231%
Dean Health $33 - $118 231%
Fallon Health $33 - $118 231%
Family Life Insurance Company $33 - $118 231%
Ghc Scw $33 - $118 231%
International Benefit Administrators $33 - $118 231%
Lifetime Benefit Solutions $33 - $118 231%
Manhattan Life $33 - $118 231%
Medi Share $33 - $118 231%
Multiplan $33 - $118 231%
Mvp $33 - $118 231%
PHCS $33 - $118 231%
Pai $33 - $118 231%
Pan-American Life $33 - $118 231%
Paramount HMO $33 - $118 231%
Trinity Health Share $33 - $118 231%
Prime Health Services $34 - $122 238%
Health Smart $37 - $130 259%
United Behavioral Health Eap $43 - $153 301%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 56 Franklin Street, Waterbury, CT 06706
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals