Hepatitis C antibody test
Facility: Ellinwood District Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $82
- Cash Discount Price: $99
- vs. Medicare Baseline: 5.75x 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 575% of the Medicare baseline (a markup of 475%). 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 | $79 - $84 | 554% |
| Blue Cross Blue Shield | $79 - $84 | 554% |
| UnitedHealthcare | $79 - $84 | 554% |
| Humana | $79 - $84 | 554% |
| Cigna | $79 - $84 | 554% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Ellinwood District Hospital in Ellinwood, KS, the cash median price is $99.00, which is lower than the negotiated rates of $82.00 paid by major insurers like Aetna, Blue Cross Blue Shield, UnitedHealthcare, Humana, and Cigna. This facility, a Critical Access Hospital owned by a government hospital district, offers a cash price that is 5.7% lower than the Medicare benchmark of $14.27, indicating a pricing structure that aligns closely with federal cost baselines rather than commercial markups. Patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the $99.00 rate avoids the administrative overhead and potential balance billing associated with insurance claims processing.
To secure the lowest possible cost, patients should proactively request a "self-pay" or "prompt-pay" discount before scheduling the test, as hospitals often offer significant fee reductions for upfront payments that bypass standard billing cycles. It is important to verify the specific discount terms with the hospital's billing department, as automatic claims submission can sometimes void cash agreements if not properly waived. While the facility's negotiated rates are consistent across the five major payers listed, consumers should be aware that commercial rates often include administrative costs that do not reflect the true cost of care, making the direct cash price a transparent and potentially more affordable option for those without immediate insurance coverage.