Hepatitis C antibody test
Facility: Clara Barton Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $38
- Cash Discount Price: $29
- vs. Medicare Baseline: 2.66x 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 266% of the Medicare baseline (a markup of 166%). 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 |
|---|---|---|
| 6 Degrees Health - All Plans | $29 | 203% |
| Wppa-All Plans | $34 | 238% |
| Aetna | $38 | 266% |
| UnitedHealthcare | $38 | 266% |
| Phcs - All Plans | $38 | 266% |
| Hlth Partners Of Ks-All Plans | $39 | 273% |
| Blue Cross Blue Shield | $45 | 315% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT code 86803) at Clara Barton Hospital in Hoisington, KS, the cash median price is $29.00, which is lower than the facility's negotiated rate of $38.00. While the hospital's negotiated rate of $38.00 aligns with the median negotiated amount for this service in Kansas, it is notably higher than the cash price. Patients with high-deductible plans may find paying the cash price of $29.00 more cost-effective if their insurance negotiated rate exceeds this amount, as the administrative overhead of insurance billing often inflates the final cost. It is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill for those choosing to pay out-of-pocket.
This service is priced at $42.00 gross, which is 2.7 times the Medicare benchmark amount of $14.27. Under Medicare benchmarking principles, fair pricing is typically defined as 120% to 150% of the Medicare rate, suggesting that the commercial negotiated rate of $38.00 falls within a reasonable range relative to the federal baseline. However, patients should be aware that hospitals often issue summary bills that obscure individual line items; requesting a full itemized CPT-coded bill is essential to identify any errors, unbundled codes, or services not rendered before finalizing payment. Additionally, while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, patients should verify their deductible status and ensure they are not inadvertently agreeing to automatic claims submission that