Hepatitis C antibody test
Facility: Stafford County Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $93
- Cash Discount Price: $98
- vs. Medicare Baseline: 6.52x 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 652% of the Medicare baseline (a markup of 552%). 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 |
|---|---|---|
| Va Ccn-All Plans | $14 | 98% |
| UnitedHealthcare | $14 | 98% |
| Health Partners-All Plans | $93 | 652% |
| Medica Mcr- All Plans | $98 | 687% |
| Humana | $98 | 687% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Stafford County Hospital, the cash price is $98.00, which matches the facility's negotiated rate and the median paid amount. This rate is significantly higher than the Medicare benchmark of $14.27, reflecting a markup common in commercial pricing where negotiated rates often average 200% to 300% of the federal baseline. While the facility is a Critical Access Hospital in Kansas, the data provided does not include specific state or county average comparisons for this procedure, so no direct regional contrast can be made against local norms.
Patients should be aware that while insurance plans negotiate a ceiling rate of $93.00, this amount may not be the lowest possible cost if the patient has a high deductible. In such cases, paying the cash price of $98.00 upfront could be more economical than the insurance negotiated rate, provided the patient has not yet met their deductible threshold. To potentially lower the final cost, patients are encouraged to ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid in full before or shortly after the service. Additionally, since the No Surprises Act prohibits balance billing for out-of-network services at in-network facilities, patients should verify that all components of the test are covered under the facility's network agreements to avoid unexpected charges.