CMS Price Transparency Data

Hepatitis C antibody test

Facility: UMass Memorial Health - Harrington Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $72
Cash Discount Price: $156
vs. Medicare Baseline: 5.05x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at UMass Memorial Health - Harrington Hospital is $72. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $156. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 5.05x the Medicare baseline. Located in 100 South Street, Southbridge, MA.

Cash / Self-Pay

$156

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: $156 (1093%)

Insurance Median: $72 (505%)

Cash: $156 (1093% 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
Medicaid / KanCare	$12 - $13	84%
Masshealth [20302]	$13	91%
Cigna	$14 - $122	98%
Institution [10406]	$14	98%
Mgb Mcr [10124]	$14	98%
Tufts Us Family [11203]	$14	98%
Aetna	$15 - $171	105%
Blue Cross Blue Shield	$15 - $45	105%
Commonwealth Care Alliance [10103]	$15	105%
Fallon Mcr Supp [20202]	$15	105%
Fallon Mcr [10105]	$15	105%
Senior Whole Health [10110]	$15	105%
Tufts Mcr [10112]	$15	105%
UnitedHealthcare	$15 - $171	105%
Workers Compensation [20501]	$16	112%
Champva [11001]	$17	119%
Tufts Connectorcare [10507]	$24	168%
Wellpoint [11112]	$30	210%
Harvard Pilgrim [10701]	$43 - $52	301%
Hne [11108]	$91 - $111	638%
Tufts [11201]	$100 - $122	701%
First Health Network [11120]	$105 - $128	736%
Evernorth Behavioral Health [27]	$112 - $137	785%
Connecticare [11105]	$140 - $171	981%
Fallon Carelon Hlth [28]	$140 - $171	981%
Fallon Mcaid Carelon Hlth [29]	$140 - $171	981%
Grants [20507]	$140 - $171	981%
Masshealth Mcd Mbhp [38]	$140 - $171	981%
Wellsense Mcaid Carelon Hlth [21]	$140 - $171	981%
Fallon Connectorcare [10503]	$141	988%
Hsno/Free Care [10801]	$681	4772%

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 $156.
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 UMass Memorial Health - Harrington 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.