Hepatitis C antibody test
Facility: Stormont Vail Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $37
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.59x 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 259% of the Medicare baseline (a markup of 159%). 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 |
|---|---|---|
| Ambetter / Centene | $15 | 105% |
| UnitedHealthcare | $15 | 105% |
| Blue Cross Blue Shield | $15 - $45 | 105% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test at Stormont Vail Hospital in Topeka, KS, the facility's negotiated rate of $37.00 is significantly lower than the state average of $90.35, offering a substantial discount for insured patients. However, because the cash median price is not available in this dataset, patients with high-deductible plans should verify if paying out-of-pocket directly could result in lower costs compared to their specific insurance allowed amount. It is important to note that while commercial insurance contracts often set a ceiling on what payers will reimburse, these negotiated rates can sometimes exceed the theoretical cash price due to administrative overhead and multi-layered billing structures.
Patients should be aware that balance billing is generally prohibited for in-network services under the No Surprises Act, meaning the hospital cannot bill you for the difference between the negotiated rate and your insurance payment. If you choose to pay cash directly, you may be eligible for a prompt-pay discount by requesting a self-pay classification before your visit, which can reduce the total cost by 20% to 50%. To ensure you are receiving the most accurate pricing, always confirm your plan's deductible status and ask the billing department to classify your account as self-pay prior to scheduling, rather than waiting to negotiate after receiving a summary bill.