CMS Price Transparency Data

Hepatitis C antibody test

Facility: Wellspan Ephrata Community Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $48
Cash Discount Price: $55
vs. Medicare Baseline: 3.36x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Wellspan Ephrata Community Hospital is $48. 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 3.36x the Medicare baseline. Located in 169 Martin Avenue, Ephrata, PA.

Cash / Self-Pay

$55

Average discount available for prompt cash payment at this facility.

Insurance Median

$48

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: $48 (336%)

Cash: $55 (385% of Medicare)

Ins. Median: $48 (336% 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 336% of the Medicare baseline (a markup of 236%). 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
Medicare (plans)	$13 - $15	91%
Aetna	$15 - $65	105%
Medicaid / KanCare	$19 - $25	133%
Highmark	$22 - $65	154%
Phc	$30 - $53	210%
Blue_Cross	$33 - $48	231%
United_Healthcare	$43	301%
Cigna	$47 - $62	329%
Geisinger	$48	336%
Independence_Blue_Cross	$48	336%
Tower Health	$48 - $51	336%
Upmc	$48 - $59	336%
Wellspan_Capital_Blue_Cross	$61	427%
First_Health_Network	$65	456%

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 Ephrata Community 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.