CMS Price Transparency Data

Hepatitis C antibody test

Facility: Wellspan York Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $59
Cash Discount Price: $55
vs. Medicare Baseline: 4.13x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Wellspan York Hospital is $59. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $55. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 4.13x the Medicare baseline. Located in 1001 South George Street, York, PA.

Cash / Self-Pay

$55

Average discount available for prompt cash payment at this facility.

Insurance Median

$59

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: $55 (385%)

Insurance Median: $59 (413%)

Cash: $55 (385% of Medicare)

Ins. Median: $59 (413% 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 413% of the Medicare baseline (a markup of 313%). 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
Johns_Hopkins_Healthcare_Plan	$14 - $70	98%
Medicare (plans)	$14 - $15	98%
Aetna	$15 - $65	105%
Medicaid / KanCare	$16 - $25	112%
Highmark	$21 - $88	147%
Blue_Cross	$36 - $67	252%
United_Healthcare	$43	301%
First_Health_Network	$59 - $64	413%
Wellspan_Capital_Blue_Cross	$61 - $68	427%
Cigna	$62 - $66	434%
Phc	$67	470%
Geisinger	$70	491%
Upmc	$70	491%

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 $55.
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 Wellspan York 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.