CMS Price Transparency Data

Hepatitis C antibody test

Facility: Sisters of Charity Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $15
Cash Discount Price: $10
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Sisters of Charity Hospital is $15. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 1.05x the Medicare baseline. Located in 2157 Main Street, Buffalo, NY.

Cash / Self-Pay

$10

Average discount available for prompt cash payment at this facility.

Insurance Median

$15

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: $10 (70%)

Insurance Median: $15 (105%)

Cash: $10 (70% of Medicare)

Ins. Median: $15 (105% 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
Tuscarora Nation [550120]	$10	70%
Univera Healthcare Essential [100170]	$10 - $12	70%
Excellus Rochester McD [350117]	$10	70%
UnitedHealthcare	$10 - $15	70%
Crime Victims [100176]	$10	70%
Beacon Essential [350122]	$10	70%
Medicaid / KanCare	$10 - $14	70%
Independent Health [100165]	$11 - $15	77%
Iha First Choice [800001]	$11	77%
Independent Health Essential [100166]	$12	84%
Tricare	$14	98%
VA Veterans Affairs [700001]	$14	98%
Cigna	$14	98%
Champ VA [700002]	$14	98%
Catholic Health Life Pace [400005]	$14	98%
Federal Workers Compensation [500100]	$14	98%
Medicare (plans)	$14 - $15	98%
Blue Cross Blue Shield	$14 - $28	98%
Hospice [550001]	$14	98%
Seneca Nation [450119]	$14	98%
Fallon Health [450115]	$14	98%
Covid19 Hrsa [45013]	$14	98%
Univera Healthcare [100169]	$15 - $21	105%
Fidelis Dual Advantage [450120]	$15	105%
Wellcare Fidelis Dual [450451]	$15	105%
Humana	$15	105%
Aetna	$15	105%
Wellcare [450129]	$15	105%
Fidelis Exchange [100164]	$21	147%
Molina Essential [100167]	$23	161%
Fidelis Essential [100163]	$23	161%
Amerigroup [350102]	$28	196%
No Fault [114001]	$32	224%
Workers Compensation [500101]	$32	224%

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 $10.
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 Sisters of Charity 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.