CMS Price Transparency Data

Hepatitis C antibody test

Facility: Woodlawn Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $43
Cash Discount Price: $148
vs. Medicare Baseline: 3.01x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Woodlawn Hospital is $43. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $148. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 3.01x the Medicare baseline. Located in 1400 E 9Th St, Rochester, IN.

Cash / Self-Pay

$148

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: $148 (1037%)

Insurance Median: $43 (301%)

Cash: $148 (1037% 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
Blue Cross Blue Shield	$6 - $150	42%
Caresource Mcaid Hww	$14	98%
Mdwise Excel Hhw & Hcc	$14	98%
Mhs Mcaid Hcc	$14	98%
Mhs Mcaid Hhw	$14	98%
UnitedHealthcare	$14 - $150	98%
Partners Direct Health-All Plans	$28	196%
Aetna	$43 - $187	301%
Caresource Mcaid Hip	$43	301%
Caresource Mcr Adv	$43	301%
Humana	$43 - $153	301%
Mdwise Mcaid Excel Hip	$43	301%
Mhs Exch Mrktplce-All Other Plans	$43	301%
Mhs Mcaid Hip	$43	301%
Mhs Mcr Adv	$44	308%
Caresource Exch - All Other Plans	$56	392%
Ambetter / Centene	$58	406%
Cigna	$141 - $167	988%
Parkview Health Plans-All Plans	$148	1037%
Sagamore All Other Grps - All Other Plans	$165	1156%
Encore Comm-All Plans	$167	1170%
Phcs/Multiplan-All Plans	$183	1282%
Community Health Alliance-All Plans	$187	1310%

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 $148.
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 Woodlawn Hospital 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.