CMS Price Transparency Data

Hepatitis C antibody test

Facility: Children's Hospital of Philadelphia

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $123
Cash Discount Price: $437
vs. Medicare Baseline: 8.62x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Children's Hospital of Philadelphia is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $437. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 8.62x the Medicare baseline. Located in 3401 Civic Center Blvd, Philadelphia, PA.

Cash / Self-Pay

$437

Average discount available for prompt cash payment at this facility.

Insurance Median

$123

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: $437 (3062%)

Insurance Median: $123 (862%)

Cash: $437 (3062% of Medicare)

Ins. Median: $123 (862% 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 862% of the Medicare baseline (a markup of 762%). 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
Geisinger Medical Assistance	$26	182%
Highmark Wholecare	$28	196%
Medicaid / KanCare	$37 - $108	259%
UnitedHealthcare	$37 - $359	259%
Health Partners	$42 - $123	294%
Aetna	$52 - $326	364%
Upmc Medical Assistance	$61 - $178	427%
Keystone First Chip	$69 - $202	484%
Keystone Health Plan East	$70 - $206	491%
Horizon Nj Health	$75	526%
Blue Cross Blue Shield	$78 - $261	547%
Geisinger Health Plan Commercial	$98 - $287	687%
Jefferson Health Plans	$105 - $309	736%
Cigna	$111 - $326	778%
Highmark	$111 - $326	778%
Qualcare	$122 - $359	855%
First Health Network	$144 - $424	1009%
Devon Health, Intergroup, Multiplan, Valley Preferred/Populytics	$177 - $522	1240%
Private Health Care Systems	$177 - $522	1240%
Choice Care Network	$200 - $587	1402%

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 $437.
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 Children's Hospital of Philadelphia 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.