CMS Price Transparency Data

Hepatitis C antibody test

Facility: Mercy Hospital Waldron

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $43
Cash Discount Price: $99
vs. Medicare Baseline: 3.01x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Mercy Hospital Waldron is $43. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $99. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 3.01x the Medicare baseline. Located in 1341 West Sixth Street, Waldron, AR.

Cash / Self-Pay

$99

Average discount available for prompt cash payment at this facility.

Insurance Median

$43

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: $99 (694%)

Insurance Median: $43 (301%)

Cash: $99 (694% of Medicare)

Ins. Median: $43 (301% 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 301% of the Medicare baseline (a markup of 201%). 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
Aetna	$13 - $99	91%
Humana	$13 - $129	91%
Medicaid / KanCare	$13 - $59	91%
United Medical Resources Contracted [320454]	$14	98%
UnitedHealthcare	$14 - $42	98%
Summit Community Care Contracted [320368]	$20	140%
Blue Cross Blue Shield	$22 - $42	154%
Usable Contracted [320409]	$22	154%
Novasys Contracted [320285]	$34 - $59	238%
Tricare	$41	287%
American Health Advantage Of Mo Mcr [20264]	$42	294%
Cherokee Nation Health Serv Contracted [320066]	$42	294%
Cross Timbers Hospice [20098]	$42	294%
Dept Of Veteran Affairs Contracted [320106]	$42	294%
Elara Caring Aspire Hospice Contracted [320433]	$42	294%
Elara Caring Aspire Hospice [20433]	$42	294%
Globalhealth Contracted [320145]	$42	294%
Halo Hcr Inc Hospice Contracted [320432]	$42	294%
Halo Hcr Inc Hospice [20432]	$42	294%
Independent Health [20197]	$42	294%
Indian Health Service Contracted [320198]	$42	294%
Indian Health Service [20198]	$42	294%
Jordan Valley Senior Care Pace [20515]	$42	294%
Kindful Hospice Contracted [320434]	$42	294%
Kindful Hospice [20434]	$42	294%
Medical Associates Health [20444]	$42	294%
Medicare (plans)	$42 - $44	294%
Mercy Hospice Okc [20252]	$42	294%
Pace Of The Ozarks [20518]	$42	294%
Provider Partners Health Plans Contracted [320450]	$42	294%
Qual Choice Contracted [320325]	$42	294%
Spina Bifida Hlthcare Benefit [20506]	$42	294%
Valir Pace [20503]	$42	294%
Cigna	$44 - $129	308%
Arkansas Total Care Contracted [320039]	$46	322%
Ambetter / Centene	$59	413%
Home State Health Plan Contracted [320187]	$59	413%
Qual Choice Contracted [320324]	$63	441%
Mercy Interfacility [20513]	$68	477%
Auxiant Contracted [320462]	$91 - $137	638%
Mercy Benefit Admin Contracted [320251]	$91 - $137	638%
Workers Comp [20426]	$99	694%
90 Degree Benefits Contracted [320436]	$129	904%
Aither Health Contracted [320449]	$129	904%
Ebms Contracted [320493]	$129	904%
Edison Health Solutions Contracted [320502]	$129	904%
Healthlink Contracted [320179]	$129 - $137	904%
Imagine 360 Contracted [320494]	$129	904%
Multiplan Contracted [320270]	$129	904%
Multiplan [20270]	$129	904%
Municipal Health Plan Contracted [320271]	$129	904%
Reflect Health Contracted [320492]	$129	904%
Show-Me Health Administrators Contracted [320483]	$129	904%
Federal Medical Center Contracted [320127]	$137	960%
Healthscope Contracted [320182]	$137	960%
Insurance System Inc Contracted [320465]	$137	960%
Personify Health Contracted [320051]	$137	960%
Point C Contracted [320238]	$137	960%
Preferred Health Plan Contracted [320522]	$137	960%
Tri State Healthcare Coalition Contracted [320379]	$137	960%

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 $99.
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 Mercy Hospital Waldron 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.