CMS Price Transparency Data

Hepatitis C antibody test

Facility: Hospital for Special Surgery

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $130
Cash Discount Price: $242
vs. Medicare Baseline: 9.11x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Hospital for Special Surgery is $130. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $242. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 9.11x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$242

Average discount available for prompt cash payment at this facility.

Insurance Median

$130

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: $242 (1696%)

Insurance Median: $130 (911%)

Cash: $242 (1696% of Medicare)

Ins. Median: $130 (911% 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 911% of the Medicare baseline (a markup of 811%). 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	$9 - $170	63%
Affinity By Molina Health Plan [1005]	$9 - $122	63%
Blue Cross Blue Shield	$9 - $234	63%
Christian Brothers [1034]	$9 - $170	63%
Connecticare [1039]	$9 - $231	63%
Emblem Health [1043]	$9 - $231	63%
Fidelis Essential [1323]	$9	63%
Harvard Pilgrim [1057]	$9 - $155	63%
Medicare (plans)	$9	63%
Meritain Health [1085]	$9 - $170	63%
Nippon Life [1092]	$9 - $170	63%
Oxford [1096]	$9 - $105	63%
Student Resources [1103]	$9 - $128	63%
UnitedHealthcare	$9 - $155	63%
Webtpa [1356]	$9 - $170	63%
Geha [1053]	$128	897%
Apwu [1016]	$129 - $144	904%
Cigna	$129 - $144	904%
Nalc [1090]	$129 - $144	904%
Qualcare [1101]	$129 - $144	904%
Wellfleet [1361]	$129 - $144	904%

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 $242.
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 Hospital for Special Surgery 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.