CMS Price Transparency Data

Hepatitis C antibody test

Facility: Mt Sinai Hospital Medical Center

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $65
  • Cash Discount Price: $133
  • vs. Medicare Baseline: 4.56x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at Mt Sinai Hospital Medical Center is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $133. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 4.56x the Medicare baseline. Located in 15Th Street at California, Chicago, IL.
Cash / Self-Pay
$133

Average discount available for prompt cash payment at this facility.

Insurance Median
$65

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: $133 (932%)
Insurance Median: $65 (456%)
Cash: $133 (932% of Medicare)
Ins. Median: $65 (456% 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 456% of the Medicare baseline (a markup of 356%). 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
Blue Cross Blue Shield $13 - $161 91%
Cigna $13 - $313 91%
Advocate Physician Prtnrs Mcr $14 98%
Cenpatico Illinicare Dual $14 98%
Cenpatico Illinicare Mcr - All Other Plans $14 98%
Humana $14 - $794 98%
Lawndale Christian - All Plans $14 - $51 98%
Meridian/Harmony D-Snp - All Plans $14 98%
Nextlevel Hlth Icp Fhp Aca - All Plans $14 98%
Tricare $14 98%
UnitedHealthcare $14 98%
Va Healthnet - All Plans $14 98%
Aetna $15 - $572 105%
Family Health Network Mcaid - All Plans $15 105%
Harmony Behavioral Htlh - All Plans $15 105%
Molina Mcr - All Other Plans $15 105%
Zing Mcr Adv - All Plans $15 105%
Advocate Physician Prtnrs - All Other Plans $16 112%
Ambetter / Centene $16 - $266 112%
Molina Mcaid $16 112%
Oscar - All Plans $36 - $139 252%
Partners In Hlth - All Plans $50 - $101 350%
Healthlink Hmo $63 - $126 441%
Healthlink Ppo - All Other Plans $63 - $126 441%
Compsych Ip/Op Only - All Plans $76 - $152 533%
Hfn Platinum $82 - $164 575%
Multiplan Primary Ntwrk/Phcs - All Other Plans $88 - $177 617%
Hfn Epo $101 - $202 708%
Multiplan Complementary Ntwrk $101 - $202 708%
Hfn Ppo - All Other Plans $111 - $223 778%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 15Th Street at California, Chicago, IL 60608
  • CMS Rating: ★☆☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals