CMS Price Transparency Data

Hepatitis C antibody test

Facility: Penn State Health St. Joseph

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $24
Cash Discount Price: $24
vs. Medicare Baseline: 1.68x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Penn State Health St. Joseph is $24. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $24. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 1.68x the Medicare baseline. Located in 2500 Bernville Road, Reading, PA.

Cash / Self-Pay

$24

Average discount available for prompt cash payment at this facility.

Insurance Median

$24

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: $24 (168%)

Insurance Median: $24 (168%)

Cash: $24 (168% of Medicare)

Ins. Median: $24 (168% 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
[Amerihealth Caritas]	$12 - $14	84%
[Highmark Wholecare]	$12 - $14	84%
[Geisinger]	$13 - $67	91%
[Health Partners Plans]	$13 - $15	91%
[Pa Health & Wellness]	$13 - $15	91%
Aetna	$14 - $48	98%
Humana	$14	98%
UnitedHealthcare	$14 - $63	98%
[Cbc]	$14 - $49	98%
[Healthspring]	$14	98%
[Highmark]	$14 - $54	98%
[Ibc]	$14 - $46	98%
[Upmc]	$15 - $69	105%
[Point Comfort Underwriters]	$18	126%
Cigna	$41 - $57	287%
[Highmark Choice Blue]	$43	301%
[Highmark Aca]	$45	315%
[Preferred Healthcare Systems]	$70	491%
[First Health]	$74	519%
[Multiplan]	$74	519%

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 $24.
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 Penn State Health St. Joseph 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.