Hepatitis C antibody test
Facility: Orthopaedic Hospital of Wisconsin
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $22
- Cash Discount Price: $144
- vs. Medicare Baseline: 1.54x 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.
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 |
|---|---|---|
| Humana | $14 - $15 | 98% |
| Blue Cross Blue Shield | $20 - $35 | 140% |
| Network Health Plan | $20 | 140% |
| Children'S Community Health Plan | $25 | 175% |
| The Alliance | $26 | 182% |
Consumer Guidance & Cost Commentary
Orthopaedic Hospital Of Wisconsin, located in Glendale, WI, offers a Hepatitis C antibody test with a cash median price of $144. This facility, owned by physicians and classified as an Acute Care Hospital, charges $272 gross for the procedure, which is significantly higher than the $14.27 Medicare amount. While the facility does not publish a specific rating, the data indicates that commercial insurance negotiated rates vary by plan, ranging from a low of $14 to a high of $35 depending on the insurer, such as Humana and Blue Cross Blue Shield.
For patients with high-deductible plans, the cash price of $144 may be more affordable than the negotiated rates charged by insurance companies, which often include administrative overhead and do not reflect the true cost baseline. It is important to note that commercial rates can sometimes exceed cash prices due to the complexity of insurance billing cycles. Patients should proactively ask the hospital about self-pay or prompt-pay discounts before scheduling, as these upfront payment options can bypass costly claims processing and reduce the final bill. Additionally, regardless of whether a patient uses insurance, they should request a full itemized CPT-coded bill to identify any errors or unbundled charges, as summary bills often obscure the actual costs of services rendered.