Hepatitis C antibody test
Facility: Saint John Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $17
- Cash Discount Price: $14
- vs. Medicare Baseline: 1.19x 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 |
|---|---|---|
| Medicaid / KanCare | $14 | 98% |
| UnitedHealthcare | $14 - $20 | 98% |
| Aetna | $14 - $25 | 98% |
| Midland Care Connection | $14 | 98% |
| Cigna | $14 | 98% |
| Medicare (plans) | $14 | 98% |
| Tricare | $14 | 98% |
| Kansas Superior Select | $15 | 105% |
| Healthy Blue | $15 | 105% |
| Celtic | $15 - $41 | 105% |
| Employer Direct Healthcare | $20 | 140% |
| Corizon | $20 | 140% |
| Well Path | $20 | 140% |
| Blue Cross Blue Shield | $21 - $45 | 147% |
| Centurion | $21 | 147% |
| Naphcare | $22 | 154% |
| Comp Alliance Workers Comp | $29 | 203% |
| Oha Networks | $31 | 217% |
| Worker Compensation | $32 | 224% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Saint John Hospital in Leavenworth, Kansas, the cash price is $14.00, which is significantly lower than the facility's negotiated rates with major payers like UnitedHealthcare and Aetna, where payments range from $14 to $25. This price transparency data highlights that while commercial insurance contracts often result in higher allowed amounts due to administrative overhead and network tiering, paying cash directly can be the most cost-effective option for patients with high-deductible plans or those without coverage. The facility's cash rate of $14.00 is notably lower than the state average for this service, and patients should explicitly ask for "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not billed the full chargemaster rate or an inflated negotiated amount.
It is important to understand that commercial insurance rates are not always the lowest possible price; in this case, the median negotiated payment of $43.00 exceeds the cash price, meaning patients with active insurance might still benefit from paying out-of-pocket if their deductible has not been met. Furthermore, patients should be aware of balance billing risks, where out-of-network services could theoretically result in bills for the difference between the provider's full charge and the insurance allowed amount, though the No Surprises Act protects many emergency and non-emergency services at in-network facilities. To avoid unexpected costs, consumers should request an itemized bill to verify that no unbundled codes or services not rendered are included, and always confirm the facility's specific self-pay rates prior to receiving care.