Hepatitis C antibody test
Facility: Ellsworth County Medical Center
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $61
- Cash Discount Price: $96
- vs. Medicare Baseline: 4.27x 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 427% of the Medicare baseline (a markup of 327%). 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 |
|---|---|---|
| Humana | $28 - $124 | 196% |
| Va Ccn-All Plans | $28 - $62 | 196% |
| Triwest -All Plans | $28 - $62 | 196% |
| Healthy Blue Mcr Adv | $28 - $62 | 196% |
| UnitedHealthcare | $39 - $131 | 273% |
| Blue Cross Blue Shield | $42 - $45 | 294% |
| First Health - All Plans | $54 - $118 | 378% |
| Aetna | $54 - $118 | 378% |
| Cigna | $57 - $124 | 399% |
| Coventry Mcaid-All Plans | $60 - $131 | 420% |
| Healthy Blue Mcaid- All Other Plans | $60 - $131 | 420% |
| Medicaid / KanCare | $60 - $131 | 420% |
| Providers Care-Wppa-All Plans | $90 - $196 | 631% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Ellsworth County Medical Center in Ellsworth, KS, the cash price is $96.00, which matches the facility's median negotiated rate of $62.00 and the state average. This test is significantly cheaper than the national average, with the cash price being 4.3 times lower than the Medicare benchmark of $14.27. While commercial insurance plans like Humana and UnitedHealthcare negotiate rates ranging from $28 to $131, these amounts are often higher than the cash price. Patients with high-deductible plans may find it financially advantageous to pay the $96.00 cash price directly, as it avoids the administrative costs and potential markups embedded in insurance negotiated rates.
To ensure you receive the most accurate pricing, it is recommended to ask the facility about "self-pay" or "prompt-pay" discounts, which can further reduce the cost before insurance billing occurs. If you are billed for this service, you should request a full itemized bill to verify that no unbundled codes or services not rendered have been charged, as over 80% of hospital bills contain errors. Additionally, if you receive a balance bill for out-of-network ancillary services, you may be protected under the No Surprises Act, which bans balance billing for emergency care and non-emergency services at in-network facilities. Always dispute any unexpected charges in writing to protect your rights and avoid unnecessary debt.