CMS Price Transparency Data

Hepatitis C antibody test

Facility: UPMC Mercy

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $98
Cash Discount Price: $168
vs. Medicare Baseline: 6.87x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at UPMC Mercy is $98. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $168. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 6.87x the Medicare baseline. Located in 1400 Locust Street, Pittsburgh, PA.

Cash / Self-Pay

$168

Average discount available for prompt cash payment at this facility.

Insurance Median

$98

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: $168 (1177%)

Insurance Median: $98 (687%)

Cash: $168 (1177% of Medicare)

Ins. Median: $98 (687% 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 687% of the Medicare baseline (a markup of 587%). 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
Upmc Health Plan	$12 - $97	84%
Geisinger	$14	98%
Upmc Work Partners	$14	98%
Aetna	$15 - $112	105%
Amerihealth Caritas	$15 - $30	105%
Highmark Wholecare (Prev Gateway)	$15 - $28	105%
Pa Health & Wellness	$15 - $32	105%
UnitedHealthcare	$22	154%
Blue Cross Blue Shield	$37 - $117	259%
Cigna	$95 - $168	666%
Bravo	$98	687%
Coventry/First Health	$123	862%
Intergroup	$140 - $224	981%
Private Health Care Systems	$210	1472%
American Healthcare Group	$224	1570%
National Provider Network	$230	1612%
Health Payors Organization	$252	1766%
Multiplan	$252	1766%

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 $168.
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 UPMC Mercy 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.