CMS Price Transparency Data

Hepatitis C antibody test

Facility: Adena Pike Medical Center

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $47
Cash Discount Price: $31
vs. Medicare Baseline: 3.29x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Adena Pike Medical Center is $47. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $31. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 3.29x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$31

Average discount available for prompt cash payment at this facility.

Insurance Median

$47

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: $31 (217%)

Insurance Median: $47 (329%)

Cash: $31 (217% of Medicare)

Ins. Median: $47 (329% 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 329% of the Medicare baseline (a markup of 229%). 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
Aetna	$15 - $103	105%
Blue Cross Blue Shield	$15 - $54	105%
Buckeye Community Health Plan	$15	105%
Care Source	$15	105%
Humana	$15 - $60	105%
Medical Mutual Of Ohio	$15 - $40	105%
Medigold	$15	105%
Molina	$15	105%
Gateway Health	$21	147%
Molina Marketplace	$25	175%
Care Source Just4Me	$27	189%
Sidecar Health	$41	287%
Ohio Ppo Connect	$44	308%
The Health Plan	$44	308%
Cigna	$45	315%
Medical Mutual Of Ohio Supermed	$47	329%
First Health	$49 - $103	343%
Ohio Health Choice	$50	350%
Integrated Health Plan	$59	413%
Healthsmart	$60	420%
Multiplan/Private Healthcare Systems	$60	420%
Three Rivers Network	$60	420%
UnitedHealthcare	$80	561%

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 $31.
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 Adena Pike 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.