CMS Price Transparency Data

Hepatitis C antibody test

Facility: St Louis Childrens Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $71
Cash Discount Price: $58
vs. Medicare Baseline: 4.98x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at St Louis Childrens Hospital is $71. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $58. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 4.98x the Medicare baseline. Located in One Childrens Place, Saint Louis, MO.

Cash / Self-Pay

$58

Average discount available for prompt cash payment at this facility.

Insurance Median

$71

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: $58 (406%)

Insurance Median: $71 (498%)

Cash: $58 (406% of Medicare)

Ins. Median: $71 (498% 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 498% of the Medicare baseline (a markup of 398%). 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
Aetna	$14 - $76	98%
UnitedHealthcare	$14 - $71	98%
Blue Cross Blue Shield	$15 - $82	105%
Cox Health [757]	$15	105%
Essence Healthcare [221]	$15	105%
Humana	$15 - $72	105%
Medica [662]	$15	105%
Cigna	$47 - $52	329%
Healthlink [225]	$47 - $72	329%
Apwu Health Plan [216]	$52	364%
Consociate [478]	$52	364%
Nalc Health Benefit Plan [242]	$52	364%
Priority Health [648]	$52	364%
Sarah Bush Lincoln [636]	$52	364%
Allied Benefits [498]	$56 - $76	392%
Hope Trust [806]	$56	392%
Cox Health Systems Insurance Company [220]	$62 - $71	434%
Med-Pay [480]	$62 - $72	434%
Unicare [568]	$62 - $72	434%
Health Alliance [224]	$67	470%
Healthscope Benefits [258]	$68 - $77	477%
First Health Commercial [734]	$71	498%
Beechstreet [551]	$72	505%
Detego Health [868]	$72	505%
Health Systems Inc [620]	$72	505%
Healthcare Sol Mercy [609]	$72	505%
Multiplan Commercial [737]	$72	505%
Multiplan [240]	$72	505%
Phcs [244]	$72 - $77	505%
Preferred Health Professionals [561]	$72	505%
Coresource [497]	$76	533%
Fmh Benefit Service Inc [222]	$76	533%
Mail Handlers [495]	$76	533%
Medica [661]	$77	540%
Hfn [563]	$82	575%

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 $58.
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 St Louis Childrens 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.