Hepatitis C antibody test
Facility: Wilson Medical Center
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $70
- Cash Discount Price: $65
- vs. Medicare Baseline: 4.91x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 491% of the Medicare baseline (a markup of 391%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | $45 - $87 | 315% |
| Humana | $46 | 322% |
| Tricare | $46 | 322% |
| Aetna | $46 - $87 | 322% |
| UnitedHealthcare | $46 - $81 | 322% |
| Ambetter / Centene | $46 - $87 | 322% |
| Cigna | $70 | 491% |
| Health Partners-All Plans | $80 | 561% |
| Mulitplan-All Plans | $80 | 561% |
Consumer Guidance & Cost Commentary
For patients paying cash, the most important thing to know is that the cash median rate for this Hepatitis C antibody test at Wilson Medical Center is $65. While commercial insurance plans often pay significantly higher amounts due to administrative overhead and contract structures, paying directly can sometimes result in lower out-of-pocket costs, particularly for those with high-deductible plans where the insurance negotiated rate exceeds the cash price. It is always advisable to ask the facility about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can further reduce the total amount owed.
When looking at the broader pricing context, the facility's cash rate of $65 is notably higher than the state average of $50 and the median negotiated rate of $70 reported for this service. The Medicare benchmark for this procedure is $14.27, which serves as the federal baseline for evaluating pricing markups; commercial rates are often 200% to 300% of this benchmark, while fair pricing is typically defined as 120% to 150%. For this specific test, the Medicare amount is $14.27, and the facility's cash rate stands at $65, representing a 4.9x difference compared to the Medicare base.