Hepatitis C antibody test
Facility: Pratt Regional Medical Center
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $199
- Cash Discount Price: $175
- vs. Medicare Baseline: 13.95x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 1395% of the Medicare baseline (a markup of 1295%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Christian Health Aid | $64 - $311 | 448% |
| UnitedHealthcare | $71 - $423 | 498% |
| Health Partners Of Kansas | $72 - $353 | 505% |
| Aetna | $77 - $374 | 540% |
| Choicecare | $85 - $415 | 596% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Pratt Regional Medical Center in Pratt, KS, the cash median price is $175.00, which is 13.9% higher than the Medicare benchmark of $14.27. While commercial insurance plans like Christian Health Aid, UnitedHealthcare, and others have negotiated rates ranging from $64 to $415, these amounts often exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash median directly, as the insurance negotiated rates frequently surpass the out-of-pocket cash cost. To secure the lowest possible price, it is essential to verify if the facility offers self-pay or prompt-pay discounts, which can reduce the bill by 20% to 50% when paid upfront, bypassing the costly claims processing cycle that inflates insurance rates.
This facility is a Proprietary Acute Care Hospital located in Pratt, KS (ZIP 67124), and while specific state or county average data for this code was not provided in the report, the facility's pricing should be evaluated against the Medicare baseline to ensure fairness. The gross chargemaster price for this service is $250.00, which serves as the maximum list price before any discounts or insurance negotiations are applied. Consumers should avoid assuming that being in-network guarantees the lowest cost, as different insurers may have varying contract terms that result in higher allowed amounts than the cash rate. Before scheduling, patients are encouraged to request an itemized bill to review specific CPT codes and ensure no unbundled charges or services not rendered are included,