CMS Price Transparency Data

Hepatitis C antibody test

Facility: Montefiore Mount Vernon Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $12
  • Cash Discount Price: $174
  • vs. Medicare Baseline: 0.84x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at Montefiore Mount Vernon Hospital is $12. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $174. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 0.84x the Medicare baseline. Located in 12 North 7Th Avenue, Mount Vernon, NY.
Cash / Self-Pay
$174

Average discount available for prompt cash payment at this facility.

Insurance Median
$12

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: $174 (1219%)
Insurance Median: $12 (84%)
Cash: $174 (1219% of Medicare)
Ins. Median: $12 (84% 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.

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
Wellcare $8 - $10 56%
Blue Cross Blue Shield $10 - $214 70%
Centerlight $10 - $11 70%
Emblem $10 - $214 70%
Fidelis $10 - $18 70%
Healthfirst $10 - $16 70%
Medicaid / KanCare $10 70%
Point Comfort $10 70%
UnitedHealthcare $10 - $29 70%
Villagecaremax $10 70%
Vnsny Choice $10 - $12 70%
Amidacare $11 77%
Humana $11 77%
Longevity $11 77%
Vnsny Select Health $12 84%
Metroplus $13 91%
Oscar $14 98%
Mvp $21 147%
American Postal Workers $29 203%
Aetna $64 - $71 448%
Cigna $139 - $155 974%
Centivo $169 1184%
Elderplan $214 1500%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 12 North 7Th Avenue, Mount Vernon, NY 10550
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals