CMS Price Transparency Data

Hepatitis C antibody test

Facility: UPMC Horizon

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $242
Cash Discount Price: $377
vs. Medicare Baseline: 16.96x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at UPMC Horizon is $242. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $377. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 16.96x the Medicare baseline. Located in 110 North Main Street, Greenville, PA.

Cash / Self-Pay

$377

Average discount available for prompt cash payment at this facility.

Insurance Median

$242

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: $377 (2642%)

Insurance Median: $242 (1696%)

Cash: $377 (2642% of Medicare)

Ins. Median: $242 (1696% 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 1696% of the Medicare baseline (a markup of 1596%). 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 - $97	91%
Upmc Work Partners	$14	98%
Aetna	$15 - $377	105%
Amerihealth Caritas	$15 - $30	105%
Cigna	$15 - $252	105%
Highmark Wholecare (Prev Gateway)	$15 - $28	105%
Pa Health & Wellness	$15 - $32	105%
UnitedHealthcare	$15 - $252	105%
Health Partners Plans (Jefferson Health Plan)	$19	133%
Geisinger	$26	182%
Blue Cross Blue Shield	$27 - $287	189%
Intergroup	$409	2866%
Coventry/First Health	$415	2908%
Health Coalition Partners	$440	3083%
Private Health Care Systems	$503	3525%
Prime Net	$516	3616%
Humana	$535	3749%

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 $377.
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 Horizon 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.