Hepatitis C antibody test
Facility: Mcpherson Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $168
- Cash Discount Price: $162
- vs. Medicare Baseline: 11.77x 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 1177% of the Medicare baseline (a markup of 1077%). 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 |
|---|---|---|
| Tricare | $13 | 91% |
| Humana | $14 | 98% |
| Blue Cross Blue Shield | $14 | 98% |
| UnitedHealthcare | $14 - $257 | 98% |
| Va Ccn - All Plans | $14 | 98% |
| Healthy Blue Mcr Adv | $14 | 98% |
| Wellcare Mcr Adv - All Plans | $14 | 98% |
| Ambetter / Centene | $16 | 112% |
| Wppa - All Plans | $43 - $180 | 301% |
| Central Plains - All Plans | $46 - $193 | 322% |
| Medical Associates - All Plans | $46 - $193 | 322% |
| Christian Health Aid - All Plans | $49 - $206 | 343% |
| Aetna | $50 - $257 | 350% |
| Multiplan - All Plans | $55 - $231 | 385% |
| First Health - All Plans | $58 - $244 | 406% |
| Cigna | $58 - $244 | 406% |
| Health Partners - All Plans | $58 - $244 | 406% |
| Medicaid / KanCare | $61 - $257 | 427% |
| Health Blue Mcaid - All Other Plans | $62 - $262 | 434% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at McPherson Hospital, the cash price is $162.00, which is lower than the facility's gross charge of $219.00. While the hospital's negotiated rates for in-network payers range from $13 to $262, the cash price is notably lower than the median negotiated rate of $168.00. For patients with high-deductible plans, paying the cash price of $162.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. Patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these can further reduce the final bill.
This service is benchmarked against the national average, where the Medicare amount of $14.27 serves as the baseline for fair pricing. The facility's cash rate of $162.00 is significantly higher than the Medicare amount, reflecting the complexity of the test and local cost structures. Because commercial negotiated rates can vary widely across different insurance plans, it is crucial to verify your specific plan's allowed amount before receiving care. If you receive a bill that includes charges beyond the negotiated rate, you may be subject to balance billing, though the No Surprises Act protects you from such unexpected costs for emergency and non-emergency services at in-network facilities. Always request a detailed, itemized bill to ensure all charges are accurate and to identify any potential errors before payment.