CMS Price Transparency Data

Hepatitis C antibody test

Facility: Wentworth-Douglass Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $142
Cash Discount Price: $122
vs. Medicare Baseline: 9.95x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Wentworth-Douglass Hospital is $142. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $122. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 9.95x the Medicare baseline. Located in 789 Central Ave, Dover, NH.

Cash / Self-Pay

$122

Average discount available for prompt cash payment at this facility.

Insurance Median

$142

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: $122 (855%)

Insurance Median: $142 (995%)

Cash: $122 (855% of Medicare)

Ins. Median: $142 (995% 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 995% of the Medicare baseline (a markup of 895%). 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
Harvard Pilgrim [120001]	$89 - $148	624%
Mgb Health Plan [150001]	$108 - $128	757%
Aetna	$142	995%
Coventry First Health [1021]	$142	995%
Harvard Pilgrim Alternate [120002]	$148	1037%
UnitedHealthcare	$148 - $157	1037%
PHCS Multiplan [1022]	$173	1212%

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 $122.
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 Wentworth-Douglass 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.