Hepatitis C antibody test
Facility: Nmc Health
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $114
- Cash Discount Price: $117
- vs. Medicare Baseline: 7.99x 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 799% of the Medicare baseline (a markup of 699%). 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 |
|---|---|---|
| Aetna | $45 | 315% |
| Blue Cross Blue Shield | $45 | 315% |
| Wppa | $70 - $113 | 491% |
| Occunet | $77 - $123 | 540% |
| Medincrease Health Plan | $83 - $133 | 582% |
| Samaritan Ministries International | $83 - $133 | 582% |
| Prime Health Services | $96 - $154 | 673% |
| UnitedHealthcare | $115 - $185 | 806% |
| Cigna | $122 - $195 | 855% |
Consumer Guidance & Cost Commentary
For this Hepatitis C antibody test at Nmc Health in Newton, KS, the cash price of $117.00 is notably lower than the facility's gross charge of $167.00. While the facility's negotiated rates for in-network payers range from $45 to $195, depending on the specific insurance plan, the cash price remains a strong baseline for comparison. It is important to note that for patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price of $117.00 upfront can be more cost-effective than relying on insurance, as the negotiated rates often exceed this amount. Additionally, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed before any insurance processing occurs.
This service is benchmarked against the federal Medicare rate of $14.27, which serves as the objective baseline for evaluating hospital pricing markups. The facility's cash price is approximately 8% higher than the Medicare amount, reflecting the complexity of the test and the provider's cost structure. While the facility is a voluntary non-profit acute care hospital with a 5-star rating, commercial insurance contracts often result in rates significantly higher than the Medicare benchmark due to administrative overhead and contract dynamics. To ensure you are receiving the most accurate pricing, always request a full itemized bill rather than accepting a summary invoice, as this allows you to verify that no unbundled codes or services not rendered have inflated your total.