Hepatitis C antibody test
Facility: F W Huston Medical Center
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $104
- Cash Discount Price: $138
- vs. Medicare Baseline: 7.29x 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 729% of the Medicare baseline (a markup of 629%). 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% |
| Aetna | $92 - $167 | 645% |
| Humana | $97 - $176 | 680% |
| Cigna | $104 - $190 | 729% |
Consumer Guidance & Cost Commentary
For this Hepatitis C antibody test at F W Huston Medical Center in Winchester, KS, the facility's cash median price is $138.00, which is lower than the state average of $173.00. While the facility's negotiated rates with major payers like Aetna and Humana range from $92 to $190, these amounts are often higher than the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the $138.00 rate is significantly lower than the negotiated amounts insurers typically pay. It is important to verify your specific plan's deductible status before relying on insurance, as paying out-of-pocket can sometimes result in immediate savings compared to the insurer's allowed amount.
To ensure you are receiving the most accurate billing information, always request a full itemized bill that lists specific CPT codes rather than accepting a summary invoice. This audit helps identify potential errors, such as unbundled charges or services not rendered, which are common in hospital billing. Additionally, if you are self-paying, ask the hospital about prompt-pay discounts, which can reduce the final cost by 20% to 50% if settled within 30 days. Since the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, they may offer specific self-pay or prompt-pay incentives that are not reflected in the standard negotiated rates. Always confirm these discounts directly with the billing department before scheduling your appointment to avoid unexpected charges.