CMS Price Transparency Data

Hepatitis C antibody test

Facility: Unitypoint Health - Meriter

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $53
Cash Discount Price: $168
vs. Medicare Baseline: 3.71x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Unitypoint Health - Meriter is $53. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $168. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 3.71x the Medicare baseline. Located in 202 S Park St, Madison, WI.

Cash / Self-Pay

$168

Average discount available for prompt cash payment at this facility.

Insurance Median

$53

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: $168 (1177%)

Insurance Median: $53 (371%)

Cash: $168 (1177% of Medicare)

Ins. Median: $53 (371% 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 371% of the Medicare baseline (a markup of 271%). 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
UnitedHealthcare	$9 - $87	63%
Aspirus	$14 - $126	98%
Blue Cross Blue Shield	$14 - $200	98%
Humana	$14	98%
Illinicare	$14	98%
Meridiancare	$14	98%
Prevea 360	$14 - $179	98%
Wellmark Uph Self-Funded	$14 - $121	98%
Health Partners Open Network	$22 - $77	154%
Cigna	$40 - $63	280%
Security Health Plan	$43 - $65	301%
Mercy Care	$50 - $70	350%
Medical Associates Health Plan	$53 - $76	371%
Quartz	$66	463%

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 $168.
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 Unitypoint Health - Meriter 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.