Hepatitis C antibody test
Facility: Ashland Health Center
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $88
- Cash Discount Price: $70
- vs. Medicare Baseline: 6.17x 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 617% of the Medicare baseline (a markup of 517%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $29 | 203% |
| Compalliance-All Plans | $70 | 491% |
| Health Partners Of Kansas-All Plans | $75 | 526% |
| Multiplan-All Plans | $86 | 603% |
| Medicare (plans) | $88 | 617% |
| Aetna | $88 | 617% |
| UnitedHealthcare | $88 | 617% |
| Health Choice-All Plans | $88 | 617% |
| Medicaid / KanCare | $88 | 617% |
| Healthy Blue Mcr Adv - All Other Plans | $88 | 617% |
| Medica Mcare - All Plans | $88 | 617% |
| Providers Care (Wppa)-All Plans | $132 | 925% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test at Ashland Health Center in Ashland, KS, the facility's negotiated rates average $88.00, which matches the median paid amount across all payers. This rate is significantly higher than the cash median of $70.00, suggesting that patients with high-deductible plans might save money by paying cash directly, provided they can secure a self-pay or prompt-pay discount before the claim is submitted. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the data does not include a facility rating. It is important to note that commercial negotiated rates often exceed cash prices due to administrative costs and contract dynamics, so patients should verify their specific plan's allowed amount and ask the billing department about immediate payment discounts prior to scheduling.
The Medicare benchmark for this service is $14.27, which serves as a baseline for evaluating the facility's pricing markup. The negotiated rate of $88.00 represents a substantial increase over the Medicare amount, reflecting the typical administrative load and contract structures inherent in commercial insurance billing. Although the data does not provide specific county or state average comparisons for this code, the disparity between the Medicare rate and the negotiated rate highlights the potential for significant cost variation depending on the payment method. Consumers should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but they must still review itemized bills to ensure no unbundled codes or services not rendered are included in the final charge.