CMS Price Transparency Data

Hepatitis C antibody test

Facility: Mountain West Medical Center

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $51
Cash Discount Price: $139
vs. Medicare Baseline: 3.57x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Mountain West Medical Center is $51. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $139. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 3.57x the Medicare baseline. Located in 2055 North Main Street, Tooele, UT.

Cash / Self-Pay

$139

Average discount available for prompt cash payment at this facility.

Insurance Median

$51

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: $139 (974%)

Insurance Median: $51 (357%)

Cash: $139 (974% of Medicare)

Ins. Median: $51 (357% 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 357% of the Medicare baseline (a markup of 257%). 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
Pehp-All Plans	$9 - $57	63%
Blue Cross Blue Shield	$14 - $16	98%
Select Health McR Adv	$14	98%
Medicare (plans)	$18	126%
Wise/Motivhealth-All Plans	$39 - $262	273%
U of Ut-All Plans	$39 - $262	273%
Dmba-All Plans	$43 - $290	301%
Cigna	$43 - $285	301%
Select Health-All Other Plans	$45 - $302	315%
Aetna	$45 - $302	315%
UnitedHealthcare	$46 - $310	322%
Multiplan Primary Network-All Other Plans	$47 - $318	329%
Humana	$51 - $342	357%
Emi-All Plans	$51 - $342	357%
Multiplan Complimentary Network	$55 - $370	385%

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 $139.
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 Mountain West Medical Center 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.