Hepatitis C antibody test
Facility: Rooks County Health Center
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $168
- Cash Discount Price: $140
- 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 |
|---|---|---|
| Blue Cross Blue Shield | $45 | 315% |
| Veterans Admin - All Plans | $88 | 617% |
| Tricare | $88 | 617% |
| Celtic Mcr Adv | $88 | 617% |
| Celtic Comm - All Other Plans | $96 | 673% |
| Aetna | $168 | 1177% |
| Preferred Benefits Admin | $168 | 1177% |
| UnitedHealthcare | $168 | 1177% |
| Health Partners - All Plans | $177 | 1240% |
| Preferred Hlthcare - All Other Plans | $177 | 1240% |
| Healthy Blue Mcaid - All Plans | $186 | 1303% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test at Rooks County Health Center in Plainville, KS, the cash price of $140.00 is lower than the facility's negotiated rates, which range from $45.00 to $187.00 depending on the insurance plan. While several payers, including Veterans Admin and Tricare, pay the exact cash amount of $45.00 to $88.00, many commercial plans such as Aetna and UnitedHealthcare pay significantly higher negotiated rates of $168.00 to $186.00. This disparity highlights that for patients with high-deductible plans, paying the cash price of $140.00 upfront can be more cost-effective than relying on insurance, which may result in higher out-of-pocket costs if the deductible has not been met. Additionally, patients should inquire about "self-pay" or "prompt-pay" discounts before scheduling, as paying the bill in full within a short window often triggers a fee reduction that bypasses the administrative costs associated with insurance claims processing.
When evaluating this price, it is important to compare the facility's rates against the Medicare benchmark rather than the gross chargemaster list. The Medicare amount for this service is $14.27, which serves as the objective baseline for fair pricing; commercial negotiated rates often average 200% to 300% of this figure, whereas fair pricing is typically defined as 120% to 150% of the Medicare rate. Although the data does not provide specific county or state average figures for this code, the facility's cash rate of $140.0