Hepatitis C antibody test
Facility: Medicine Lodge Memorial Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $62
- Cash Discount Price: $67
- vs. Medicare Baseline: 4.34x 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 434% of the Medicare baseline (a markup of 334%). 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 |
|---|---|---|
| Tricare | $48 - $54 | 336% |
| Humana | $54 - $61 | 378% |
| Aetna | $55 - $67 | 385% |
| UnitedHealthcare | $56 - $64 | 392% |
| Hpk-All Plans | $56 - $64 | 392% |
| Medicaid / KanCare | $59 - $67 | 413% |
Consumer Guidance & Cost Commentary
For this Hepatitis C antibody test at Medicine Lodge Memorial Hospital, the cash price of $67.00 is identical to the facility's median negotiated rate, which is also $67.00. This suggests that for patients without insurance, paying out-of-pocket is the most cost-effective option. In contrast, the facility's negotiated rates for insured patients range from $48 to $67 depending on the payer, with the lowest allowed amount being $48 for Tricare plans. While commercial payers like Aetna and Medicaid/KanCare have higher negotiated ceilings of $67, the cash price remains competitive. It is important to note that while cash payment avoids insurance deductibles and copays, patients should verify if their specific plan has a deductible that exceeds the cash price, as paying the full negotiated rate could result in higher out-of-pocket costs than paying cash directly.
The facility's pricing structure is significantly lower than the Medicare benchmark, with the cash price of $67.00 representing a 4.3% increase over the Medicare amount of $14.27 for this service. This indicates that the facility is charging well below the federal government's cost-based reimbursement rate, which serves as a reliable baseline for fair pricing. Given that the facility is a Critical Access Hospital in Medicine Lodge, KS, and is owned by a Government Hospital District, patients should proactively ask about "prompt-pay" discounts or self-pay rates before scheduling, as these can further reduce the final bill. Additionally, if a patient receives care from an out-of-network provider at this facility, they may be protected from balance billing by the No Surprises Act for non-emergency services, though they should still request an