CMS Price Transparency Data

Hepatitis C antibody test

Facility: Waverly Health Center

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $80
Cash Discount Price: $68
vs. Medicare Baseline: 5.61x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Waverly Health Center is $80. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $68. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 5.61x the Medicare baseline. Located in 312 9Th Street Sw, Waverly, IA.

Cash / Self-Pay

$68

Average discount available for prompt cash payment at this facility.

Insurance Median

$80

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: $68 (477%)

Insurance Median: $80 (561%)

Cash: $68 (477% of Medicare)

Ins. Median: $80 (561% 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 561% of the Medicare baseline (a markup of 461%). 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
Wellmark Hmo	$40	280%
Choicecare Network - All Plans	$44 - $57	308%
UnitedHealthcare	$44 - $104	308%
Wellmark Ppo - All Other Plans	$44	308%
Medicare (plans)	$49 - $64	343%
Midlands Choice Mcare	$49 - $64	343%
Hlth Partners Bridges Ntwrk	$80 - $103	561%
Hlth Partners Open Ntwrk - All Other Plans	$80 - $103	561%
Aetna	$98 - $126	687%
Health Alliance-All Plans	$104 - $133	729%
Midlands Choice-All Other Plans	$104 - $133	729%

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 $68.
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 Waverly Health 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.