Hepatitis C antibody test
Facility: Hamilton County Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $68
- Cash Discount Price: $76
- vs. Medicare Baseline: 4.77x 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 477% of the Medicare baseline (a markup of 377%). 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 | $21 - $45 | 147% |
| First Health Coventry - All Plans | $65 | 456% |
| Cigna | $72 | 505% |
| UnitedHealthcare | $72 | 505% |
| Va Ccn - All Plans | $76 | 533% |
| Aetna | $129 | 904% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test at Hamilton County Hospital in Syracuse, KS, the cash price is $76.00, which matches the facility's gross chargemaster rate. While the median negotiated rate across six payers is $68.00 and the median amount paid by insurers is $72.00, the cash price remains the lowest option available for this service. It is important to note that for patients with high-deductible plans, paying the cash price of $76.00 upfront can sometimes be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash price due to administrative overhead and contract dynamics. Patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the final cost.
This service is priced significantly higher than the state average, with the Medicare benchmark rate set at $14.27, indicating a substantial markup relative to federal cost standards. However, the facility is a Critical Access Hospital owned by the local government, which may influence pricing structures compared to private providers. To ensure you are not overcharged, it is advisable to request a full itemized billing audit if you receive a summary bill, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. If you encounter a balance bill from an out-of-network provider, you may be protected under the No Surprises Act, which bans balance billing for emergency care and non-emergency services at in-network facilities, so you should dispute any unexpected charges rather than paying immediately.