CMS Price Transparency Data

Hepatitis C antibody test

Facility: Progress West Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $66
Cash Discount Price: $61
vs. Medicare Baseline: 4.63x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Progress West Hospital is $66. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $61. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 4.63x the Medicare baseline. Located in 2 Progress Point Pkwy, Ofallon, MO.

Cash / Self-Pay

$61

Average discount available for prompt cash payment at this facility.

Insurance Median

$66

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: $61 (427%)

Insurance Median: $66 (463%)

Cash: $61 (427% of Medicare)

Ins. Median: $66 (463% 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 463% of the Medicare baseline (a markup of 363%). 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
UnitedHealthcare	$15 - $75	105%
Healthscope Benefits [258]	$17	119%
Cigna	$20 - $31	140%
Aetna	$25 - $76	175%
Allied Benefits [498]	$25 - $75	175%
Consociate [478]	$25	175%
Coresource [497]	$25	175%
Fmh Benefit Service Inc [222]	$25	175%
Mail Handlers [495]	$25	175%
Sarah Bush Lincoln [636]	$25	175%
Apwu Health Plan [216]	$31	217%
Nalc Health Benefit Plan [242]	$31	217%
Priority Health [648]	$31	217%
Blue Cross Blue Shield	$34 - $88	238%
Humana	$40	280%
Healthlink [225]	$49 - $76	343%
Cox Health Systems Insurance Company [220]	$56 - $66	392%
Health Alliance [224]	$56	392%
Hope Trust [806]	$59	413%
Med-Pay [480]	$66 - $76	463%
Unicare [568]	$66 - $76	463%
First Health Commercial [734]	$75	526%
Beechstreet [551]	$76	533%
Detego Health [868]	$76	533%
Health Systems Inc [620]	$76	533%
Healthcare Sol Mercy [609]	$76	533%
Multiplan Commercial [737]	$76	533%
Multiplan [240]	$76	533%
Phcs [244]	$76 - $81	533%
Preferred Health Professionals [561]	$76	533%
Hfn [563]	$81	568%
Medica [661]	$81	568%
Mh Magellan Health Services [270]	$101	708%

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 $61.
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 Progress West 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.