Hepatitis C antibody test
Facility: Hiawatha Community Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $123
- Cash Discount Price: $158
- vs. Medicare Baseline: 8.62x 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 862% of the Medicare baseline (a markup of 762%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $43 - $45 | 301% |
| UnitedHealthcare | $58 - $136 | 406% |
| Aetna | $58 - $128 | 406% |
| Humana | $59 | 413% |
| Ambetter / Centene | $70 | 491% |
| Oscar - All Plans | $118 | 827% |
| Centrus Health Direct - All Plans | $118 | 827% |
| Preferred Hlth - All Plans | $142 | 995% |
| Cigna | $150 | 1051% |
| Wppa Providrs Care - All Plans | $150 | 1051% |
| Midlands Choice - All Plans | $153 | 1072% |
| Multiplan - All Plans | $153 | 1072% |
| Healthy Blue Mcaid - All Plans | $158 | 1107% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $158.00, which matches the facility's gross charge and the state average. While many commercial payers negotiate rates significantly lower than the cash price—ranging from $43 to $158 depending on the plan—this specific test is notably expensive for self-pay patients compared to the national average. Although the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the cash rate here is higher than the typical negotiated rates seen for this procedure. Patients with high-deductible plans or those without insurance should consider paying cash directly, as the $158.00 rate may be lower than the allowed amounts some insurers would pay, potentially saving money on out-of-pocket costs.
To ensure you receive the most accurate and fair pricing, it is essential to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, you should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the administrative costs associated with insurance claims. While the Medicare benchmark for this service is $14.27, commercial rates often exceed this baseline due to administrative overhead; however, the cash price of $158.00 remains the most transparent figure for comparison. Always verify your specific plan's deductible status and network tiering, as assuming an in-network rate is the best price