Hepatitis C antibody test
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $27
- Cash Discount Price: $139
- vs. Medicare Baseline: 1.89x 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 |
|---|---|---|
| First Health Contracted [320128] | $12 | 84% |
| UnitedHealthcare | $12 - $198 | 84% |
| United Medical Resources Contracted [320454] | $12 - $39 | 84% |
| Aetna | $12 - $14 | 84% |
| Blue Cross Blue Shield | $13 - $32 | 91% |
| Humana | $13 - $14 | 91% |
| Medicaid / KanCare | $13 - $20 | 91% |
| Mercy Mgd Behavioral Health Contracted [320259] | $14 | 98% |
| Medicare (plans) | $14 | 98% |
| Kindful Hospice Contracted [320434] | $14 | 98% |
| Medica Contracted [320239] | $14 | 98% |
| Tricare | $14 | 98% |
| Cross Timbers Hospice [20098] | $14 | 98% |
| Globalhealth Contracted [320145] | $14 | 98% |
| Cherokee Nation Health Serv Contracted [320066] | $14 | 98% |
| Halo Hcr Inc Hospice Contracted [320432] | $14 | 98% |
| Kindful Hospice [20434] | $14 | 98% |
| Cigna | $14 - $82 | 98% |
| Dept Of Veteran Affairs Contracted [320106] | $14 | 98% |
| Elara Caring Aspire Hospice [20433] | $14 | 98% |
| Pace Of The Ozarks Contracted [320518] | $14 | 98% |
| Halo Hcr Inc Hospice [20432] | $14 | 98% |
| Medical Associates Health Contracted [320444] | $14 | 98% |
| Qual Choice Contracted [320325] | $14 | 98% |
| Mercy Hospice Okc [20252] | $14 | 98% |
| Provider Partners Health Plans Contracted [320450] | $15 | 105% |
| Centivo Contracted [320505] | $24 | 168% |
| Providrs Care Network Contracted [320484] | $27 | 189% |
| Point C Contracted [320238] | $39 - $160 | 273% |
| Health Systems Inc Contracted [320174] | $39 | 273% |
| Healthscope Contracted [320182] | $39 - $160 | 273% |
| Benefit Management Contracted [320052] | $39 | 273% |
| Insurance System Inc Contracted [320465] | $39 | 273% |
| Show-Me Health Administrators Contracted [320483] | $88 | 617% |
| Mercy Benefit Admin Contracted [320251] | $88 - $150 | 617% |
| Auxiant Contracted [320462] | $150 - $160 | 1051% |
| Aither Health Contracted [320449] | $150 | 1051% |
| Ebms Contracted [320493] | $150 | 1051% |
| American Healthcare Alliance Contracted [320020] | $150 | 1051% |
| Yuzu Health Contracted [320521] | $150 | 1051% |
| Reflect Health Contracted [320492] | $150 | 1051% |
| Imagine 360 Contracted [320494] | $150 | 1051% |
| Edison Health Solutions Contracted [320502] | $150 | 1051% |
| Preferred Health Plan Contracted [320522] | $160 | 1121% |
| Federal Medical Center Contracted [320127] | $160 | 1121% |
| Healthlink Contracted [320179] | $160 | 1121% |
| Compcare Of The Ozarks Contracted [320437] | $169 | 1184% |
| Workers Comp [20426] | $171 | 1198% |
| Private Health Care Systems Contracted [320320] | $198 | 1388% |
| Multiplan [20270] | $203 | 1423% |
| Multiplan Contracted [320270] | $203 | 1423% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803), the gross charge at Mercy Specialty Hospital Southeast Kansas is $214.00. While the facility offers a cash median price of $139.00, which is lower than the negotiated rates paid by most insurance plans, patients should be aware that commercial payers often negotiate rates significantly higher than cash prices. For instance, UnitedHealthcare's negotiated range spans from $12 to $198, and Point C's range extends up to $160. If you have a high-deductible plan or have not yet met your deductible, paying the cash price of $139.00 upfront could result in immediate savings compared to the insurance allowed amount, provided you secure a prompt-pay discount before the claim is submitted.
The facility's cash rate of $139.00 is notably higher than the state average for this service, which is approximately $27.00 based on the median negotiated rate reported for the region. However, this comparison highlights that while the facility's cash price exceeds the regional average, the negotiated rates for many commercial payers also exceed the cash price, making self-pay a potentially more economical option for those without active coverage. To maximize savings, patients should explicitly request a "self-pay" or "prompt-pay" discount prior to scheduling, as billing systems often default to insurance processing once a card is on file. Additionally, because the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients should verify their network status and ensure no out-of-network ancillary services are billed to avoid unexpected charges.