Hepatitis C antibody test
Facility: Stevens County Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $46
- Cash Discount Price: $120
- vs. Medicare Baseline: 3.22x 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 322% of the Medicare baseline (a markup of 222%). 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 |
|---|---|---|
| Aetna | $17 - $120 | 119% |
| Blue Cross Blue Shield | $43 - $45 | 301% |
| Humana | $44 | 308% |
| First Health - All Plans | $108 | 757% |
| Wppa - All Plans | $114 | 799% |
| Medicaid / KanCare | $120 | 841% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test at Stevens County Hospital in Hugoton, Kansas, the cash price is $120.00, which matches the facility's gross chargemaster rate. While the median negotiated rate across six payers is $46.00, this figure represents what insurers typically pay after applying their own contracts and deductibles, not necessarily what a patient would owe out-of-pocket. It is important to note that for patients with high-deductible plans, paying the full cash price of $120.00 upfront can sometimes be more cost-effective than relying on insurance, especially if the insurer's negotiated rate exceeds the cash price or if the patient has not yet met their deductible. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can offer further reductions for those paying in full before or shortly after the service.
This specific service is benchmarked against federal standards, where the Medicare amount for this code is $14.27. The facility's cash price of $120.00 is 3.2 times the Medicare rate, reflecting the standard markup structure for commercial services. While the data does not provide specific state or county average comparisons for this exact procedure, the significant difference between the Medicare baseline and the cash price highlights the importance of understanding the true cost versus the listed price. To avoid unexpected costs, consumers should request an itemized bill to verify that no unbundled charges or services not rendered are included, as over 80% of hospital bills contain errors. If a balance bill arises from an out-of-network ancillary service, patients should dispute the charge with their insurer under the No Surprises Act rather