CMS Price Transparency Data

Hepatitis C antibody test

Facility: Holy Cross Hospital - Salt Lake

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $136
Cash Discount Price: $115
vs. Medicare Baseline: 9.53x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Holy Cross Hospital - Salt Lake is $136. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $115. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 9.53x the Medicare baseline. Located in 1050 East South Temple, Salt Lake City, UT.

Cash / Self-Pay

$115

Average discount available for prompt cash payment at this facility.

Insurance Median

$136

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: $115 (806%)

Insurance Median: $136 (953%)

Cash: $115 (806% of Medicare)

Ins. Median: $136 (953% 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 953% of the Medicare baseline (a markup of 853%). 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
Blue Cross Blue Shield	$10 - $172	70%
Cigna	$12 - $230	84%
Denver Health	$12	84%
Health Choice	$12	84%
Medicaid / KanCare	$12	84%
Rocky Mountain Health Plan	$12	84%
Uuhp	$12 - $31	84%
Humana	$14	98%
Medicare (plans)	$14	98%
Centura Employee Plan	$18	126%
Employer Direct Healthcare	$18	126%
UnitedHealthcare	$18	126%
Motivhealth	$19	133%
Molina	$29 - $123	203%
Pehp	$123 - $287	862%
Aetna	$127 - $242	890%
Wise	$149 - $152	1044%
Deseret Mutual Benefit Administrators	$176	1233%
Select Health	$190	1331%
Multiplan	$198 - $261	1388%
Emi Health	$287	2011%

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 $115.
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 Holy Cross Hospital - Salt Lake 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.