CMS Price Transparency Data

Hepatitis C antibody test

Facility: Highland Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $14
Cash Discount Price: $70
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Highland Hospital is $14. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $70. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 0.98x the Medicare baseline. Located in 1000 South Avenue, Rochester, NY.

Cash / Self-Pay

$70

Average discount available for prompt cash payment at this facility.

Insurance Median

$14

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: $70 (491%)

Insurance Median: $14 (98%)

Cash: $70 (491% of Medicare)

Ins. Median: $14 (98% 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.

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	$9 - $23	63%
Medicare (plans)	$9 - $14	63%
Highmark Bc/Bs Of Western Ny [5143]	$10	70%
Cigna	$11 - $13	77%
Fidelis [5155]	$11 - $23	77%
Mvp [2900]	$11 - $14	77%
Excellus Bc/Bs [2201], Bc/Bs Out Of Area [2401]	$12 - $48	84%
Independent Health [5156]	$12 - $21	84%
UnitedHealthcare	$12 - $24	84%
Molina Healthcare [5189], Molina Healthcare [1723]	$13 - $23	91%
Aetna	$14 - $24	98%
Amerigroup (Bswny Alternate) [1720]	$14	98%
Capital District Physicians Health Plan (Cdphp) [5149]	$14	98%
Elderplan [1316]	$14	98%
Excellus Bc/Bs [2201]	$14 - $26	98%
Excellus [2201]	$14 - $16	98%
Icircle [1728]	$14	98%
Martins Point [1205]	$14	98%
Nascentia [1729]	$14	98%
Humana	$17 - $18	119%

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 $70.
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 Highland 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.