CMS Price Transparency Data

Hepatitis C antibody test

Facility: UPMC Northwest

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $74
Cash Discount Price: $91
vs. Medicare Baseline: 5.19x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at UPMC Northwest is $74. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $91. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 5.19x the Medicare baseline. Located in 100 Fairfield Drive, Seneca, PA.

Cash / Self-Pay

$91

Average discount available for prompt cash payment at this facility.

Insurance Median

$74

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: $91 (638%)

Insurance Median: $74 (519%)

Cash: $91 (638% of Medicare)

Ins. Median: $74 (519% 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 519% of the Medicare baseline (a markup of 419%). 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	$13 - $27	91%
Blue Cross Blue Shield	$14 - $117	98%
Geisinger	$14	98%
Upmc Work Partners	$14	98%
Aetna	$15 - $98	105%
Amerihealth Caritas	$15 - $30	105%
Highmark Wholecare (Prev Gateway)	$15 - $28	105%
Pa Health & Wellness	$15 - $32	105%
UnitedHealthcare	$15 - $22	105%
Cigna	$60 - $98	420%
Intergroup	$98 - $3,704	687%
Coventry/First Health	$106	743%
Health Coalition Partners	$109	764%
Private Health Care Systems	$121	848%
Humana	$128	897%

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 $91.
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 Northwest 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.