CMS Price Transparency Data

Hepatitis C antibody test

Facility: Wabash General Hospital 1

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $37
Cash Discount Price: $49
vs. Medicare Baseline: 2.59x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Wabash General Hospital 1 is $37. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $49. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 2.59x the Medicare baseline. Located in 1418 College Drive, Mount Carmel, IL.

Cash / Self-Pay

$49

Average discount available for prompt cash payment at this facility.

Insurance Median

$37

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: $49 (343%)

Insurance Median: $37 (259%)

Cash: $49 (343% of Medicare)

Ins. Median: $37 (259% 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 259% of the Medicare baseline (a markup of 159%). 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
Blue Cross Blue Shield	$13 - $47	91%
Health Alliance Mcr Adv - All Plans	$14 - $17	98%
UnitedHealthcare	$14 - $47	98%
Aetna	$23 - $45	161%
Meridian Mcaid - All Plans	$23	161%
Molina Mcaid - All Plans	$23	161%
Healthlink Hmo	$31 - $37	217%
Cigna	$34 - $40	238%
Encore Combined Ip/Op Only	$34 - $40	238%
Hope Trust - All Plans	$34 - $40	238%
Healthlink Ppo - All Other Plans	$36 - $43	252%
Phcs - All Plans	$36 - $43	252%
Health Smart - All Plans	$38 - $45	266%
Hfn - All Plans	$38 - $45	266%
Multiplan - All Plans	$38 - $45	266%
Siho Network - All Plans	$38 - $45	266%
Encore Health Network Ip/Op Only - All Other Plans	$40 - $48	280%

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 $49.
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 Wabash General Hospital 1 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.