CMS Price Transparency Data

Hepatitis C antibody test

Facility: Wilkes Regional Medical Center

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $131
Cash Discount Price: $128
vs. Medicare Baseline: 9.18x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Wilkes Regional Medical Center is $131. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $128. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 9.18x the Medicare baseline. Located in 1370 West D St, North Wilkesboro, NC.

Cash / Self-Pay

$128

Average discount available for prompt cash payment at this facility.

Insurance Median

$131

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: $128 (897%)

Insurance Median: $131 (918%)

Cash: $128 (897% of Medicare)

Ins. Median: $131 (918% 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 918% of the Medicare baseline (a markup of 818%). 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
Healthteam	$15	105%
Alliance	$26	182%
Amerihealth	$26 - $149	182%
Carolina Complete	$26	182%
Healthblue	$26	182%
Partners	$26	182%
UnitedHealthcare	$26 - $137	182%
Vaya	$26	182%
Wellcare	$26	182%
Trillium	$27	189%
Medcost	$74 - $183	519%
Aetna	$97 - $176	680%
Blue Cross Blue Shield	$99 - $149	694%
Ambetter / Centene	$121 - $156	848%
Cigna	$134 - $139	939%
Oscar	$141 - $166	988%
Directnet	$151	1058%
Private Healthcare Systems	$230	1612%
Multiplan	$236	1654%

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 $128.
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 Wilkes Regional Medical 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.