Hepatitis C antibody test
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $24
- Cash Discount Price: $112
- vs. Medicare Baseline: 1.68x 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 |
|---|---|---|
| Blue Cross Blue Shield | $13 - $54 | 91% |
| Medicaid / KanCare | $13 - $24 | 91% |
| Aetna | $13 - $146 | 91% |
| UnitedHealthcare | $13 - $116 | 91% |
| Humana | $13 - $14 | 91% |
| Medicare (plans) | $14 | 98% |
| Dept Of Veteran Affairs Contracted [320106] | $14 | 98% |
| Mercy Hospice Okc [20252] | $14 | 98% |
| Pace Of The Ozarks Contracted [320518] | $14 | 98% |
| Cross Timbers Hospice [20098] | $14 | 98% |
| Medica Contracted [320239] | $14 | 98% |
| Halo Hcr Inc Hospice [20432] | $14 | 98% |
| Kindful Hospice [20434] | $14 | 98% |
| Halo Hcr Inc Hospice Contracted [320432] | $14 | 98% |
| Elara Caring Aspire Hospice [20433] | $14 | 98% |
| Kindful Hospice Contracted [320434] | $14 | 98% |
| Tricare | $14 | 98% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $15 | 105% |
| Health Choice Contracted [320166] | $19 | 133% |
| Home State Health Plan Contracted [320187] | $24 | 168% |
| Ambetter / Centene | $24 | 168% |
| Providrs Care Network Contracted [320484] | $27 | 189% |
| Cigna | $80 - $82 | 561% |
| United Medical Resources Contracted [320454] | $116 | 813% |
| Edison Health Solutions Contracted [320502] | $138 | 967% |
| Auxiant Contracted [320462] | $138 | 967% |
| Yuzu Health Contracted [320521] | $138 | 967% |
| Imagine 360 Contracted [320494] | $138 | 967% |
| Aither Health Contracted [320449] | $138 | 967% |
| Workers Comp [20426] | $138 | 967% |
| Healthlink Contracted [320179] | $138 | 967% |
| Mercy Benefit Admin Contracted [320251] | $138 | 967% |
| Ebms Contracted [320493] | $138 | 967% |
| Reflect Health Contracted [320492] | $138 | 967% |
| American Healthcare Alliance Contracted [320020] | $138 | 967% |
| First Health Contracted [320128] | $146 | 1023% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT code 86803) at Mercy Hospital Pittsburg, Inc., the cash price of $112.00 is significantly lower than the negotiated rates paid by most insurance plans, which range from $13 to $146 depending on the carrier. While the facility's cash rate is higher than the state average of $15.00 for this service, patients with high-deductible plans or those who have met their deductible may find the cash price more affordable than the insurance negotiated rate. It is important to note that many commercial payers, including Blue Cross Blue Shield, Aetna, and UnitedHealthcare, have negotiated rates exceeding the cash price, meaning paying out-of-pocket upfront could result in immediate savings compared to the amount an insurer would allow.
The facility's cash rate of $112.00 is also notably higher than the Medicare benchmark of $14.27, which serves as a federal cost baseline for this procedure. Although the facility is a voluntary non-profit church-owned hospital, the gap between the cash price and the Medicare rate highlights the markup inherent in commercial billing structures. To optimize costs, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as these upfront payment incentives can reduce the bill by 20% to 50%. Additionally, because the No Surprises Act prohibits balance billing for out-of-network services at in-network facilities, patients should verify that all ancillary services, such as lab work, are covered under the facility's network agreements to avoid unexpected additional charges.