CMS Price Transparency Data

Hepatitis C antibody test

Facility: UW Health

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $97
Cash Discount Price: $70
vs. Medicare Baseline: 6.80x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at UW Health is $97. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $70. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 6.80x the Medicare baseline. Located in 1401 East State Street, Rockford, IL.

Cash / Self-Pay

$70

Average discount available for prompt cash payment at this facility.

Insurance Median

$97

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: $70 (491%)

Insurance Median: $97 (680%)

Cash: $70 (491% of Medicare)

Ins. Median: $97 (680% 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 680% of the Medicare baseline (a markup of 580%). 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	$14 - $202	98%
Blue Cross Blue Shield	$14 - $138	98%
Humana	$14	98%
Medicare (plans)	$14 - $16	98%
Mychoice Wi Medical Adv	$14	98%
UnitedHealthcare	$14 - $23	98%
Quartz Fully Insured	$97	680%
Ecoh	$142 - $220	995%
Hfn	$142 - $220	995%
Alliance Premier Network	$153	1072%
Quartz Aso	$153	1072%
The Alliance	$196	1374%
Wps Ppo	$216	1514%
Cigna	$223	1563%
Beloit Healt System	$252	1766%
Mercycare	$261	1829%
First Health/Coventry	$275	1927%
Health Payment Systems	$326	2285%
Healthsmart	$326	2285%
Sheboygan Employers Health Network	$348	2439%
Multiplan	$389	2726%

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 $70.
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 UW Health 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.