CMS Price Transparency Data

Hepatitis C antibody test

Facility: Boston Children's Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $78
Cash Discount Price: $151
vs. Medicare Baseline: 5.47x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Boston Children's Hospital is $78. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $151. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 5.47x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$151

Average discount available for prompt cash payment at this facility.

Insurance Median

$78

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: $151 (1058%)

Insurance Median: $78 (547%)

Cash: $151 (1058% of Medicare)

Ins. Median: $78 (547% 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 547% of the Medicare baseline (a markup of 447%). 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
Cdphp	$41 - $186	287%
Harvard Pilgrim	$42 - $148	294%
Unicare	$46	322%
Blue Cross Blue Shield	$47 - $145	329%
Aetna	$50 - $184	350%
Mgb/Allways	$50 - $162	350%
United	$50 - $183	350%
Tufts Public Plan	$51 - $135	357%
Ambetter / Centene	$52 - $138	364%
United Ri Nj Ny	$52 - $138	364%
Carelon Strategies/Bhs	$54 - $142	378%
UnitedHealthcare	$54 - $186	378%
Carelon/Beacon	$62 - $164	434%
Fallon	$63 - $169	441%
Health New England	$67 - $177	470%
Cigna	$71 - $198	498%
Ets/Lifetrac	$71 - $186	498%
Interlink Transplant	$71 - $186	498%
Community Health Options	$75 - $197	526%
Humana	$75 - $197	526%
Coventry/Hcvm/First Health	$76 - $201	533%
Multiplan/Phcs	$76 - $208	533%

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 $151.
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 Boston Children'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.