Hepatitis C antibody test
Facility: Graham County Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $47
- Cash Discount Price: $65
- vs. Medicare Baseline: 3.29x 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 329% of the Medicare baseline (a markup of 229%). 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 | $9 - $62 | 63% |
| Medicaid / KanCare | $23 | 161% |
| Blue Cross Blue Shield | $45 | 315% |
| Medicare (plans) | $49 | 343% |
| Celtic Commercial-All Other Plans | $54 | 378% |
| Wppa (Providers Care)-All Plans | $62 | 434% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test at Graham County Hospital, the cash price is $65.00, which matches the facility's median paid amount. This cash rate is significantly lower than the negotiated rates paid by major payers, with UnitedHealthcare paying $9.00 to $62.00 and Medicaid/KanCare paying exactly $23.00. The facility's cash price is notably higher than the state average for this service, which is $47.00, and also exceeds the Medicare benchmark of $14.27. Because the cash price is higher than the state average, patients with high-deductible plans may find it beneficial to pay the full cash price of $65.00 upfront, as this avoids the administrative costs and potential higher negotiated rates that insurance plans often apply.
Patients should be aware that while the facility is a Critical Access Hospital in Hill City, KS, and is owned by the local government, the final amount owed depends on your specific insurance coverage. If you have insurance, the facility will likely submit a claim to your plan, and you may be responsible for the difference between your plan's allowed amount and the cash price if you do not meet your deductible. To ensure you receive the best possible rate, it is recommended to contact the hospital directly to confirm if they offer a "self-pay" or "prompt-pay" discount for upfront payment. Additionally, if you receive an itemized bill, you should request a full line-by-line audit to verify that all charges are accurate and that no services were bundled incorrectly, as over 80% of hospital bills contain errors that can be disputed.