Hepatitis C antibody test
Facility: Holton Community Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $64
- Cash Discount Price: $58
- vs. Medicare Baseline: 4.48x 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 448% of the Medicare baseline (a markup of 348%). 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 |
|---|---|---|
| UnitedHealthcare | $41 - $77 | 287% |
| Aetna | $41 - $77 | 287% |
| Humana | $41 | 287% |
| Kansas Superior Select - All Plans | $42 | 294% |
| Blue Cross Blue Shield | $45 | 315% |
| Preferred Health Professionals | $64 | 448% |
| Preferred Health Freedom | $64 | 448% |
| Preferred Health Fn Select - All Other Plans | $64 | 448% |
| Wppa Providers - All Plans | $73 | 512% |
| Medicaid / KanCare | $77 | 540% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT code 86803) at Holton Community Hospital in Holton, Kansas, the facility's cash median price is $58.00, which is lower than the state average of $64.00. While commercial insurance plans like UnitedHealthcare and Aetna negotiate a maximum payment of $77.00, this rate is significantly higher than the cash price, meaning patients with high-deductible plans might save money by paying the cash rate directly. The facility, a voluntary non-profit Critical Access Hospital, offers a negotiated rate of $64.00 for in-network members, but this amount exceeds the cash price, highlighting that being in-network does not always guarantee the lowest possible cost for this specific service.
To minimize out-of-pocket expenses, patients should proactively ask the hospital about self-pay or prompt-pay discounts before scheduling, as these upfront payment incentives can reduce the bill by 20% to 50%. It is also important to request an itemized billing audit to ensure no errors or unbundled charges are included, as over 80% of hospital bills contain mistakes that can be corrected. Finally, while the facility's negotiated rates are higher than the Medicare benchmark of $14.27, the cash price remains the most transparent baseline for comparison, and patients should verify their deductible status to avoid unexpected costs if they choose to use insurance coverage.