Hepatitis C antibody test
Facility: Hospital District #6 Patterson Health Center
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $68
- Cash Discount Price: $60
- vs. Medicare Baseline: 4.77x 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 477% of the Medicare baseline (a markup of 377%). 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 | $42 - $45 | 294% |
| UnitedHealthcare | $68 - $75 | 477% |
| Providers Care (Wppa)-All Plans | $131 | 918% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Hospital District #6 Patterson Health Center in Anthony, KS, the facility's negotiated rates range from $42 to $75, with a median of $68. This aligns closely with the state average, as the median paid amount of $68 matches the median negotiated rate exactly. While the facility's cash price is $60, which is lower than the negotiated rate, patients with high-deductible plans should consider that paying cash upfront might save money if their insurance allows the full negotiated amount. It is important to verify your specific plan's deductible status before scheduling, as paying the full negotiated rate without meeting your deductible can result in significantly higher out-of-pocket costs than the cash price.
The facility's billing practices reflect standard industry dynamics where commercial rates often exceed the Medicare benchmark of $14.27 for this service. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still request a detailed itemized bill to ensure no unbundled codes or services not rendered are included. Additionally, since this is a Critical Access Hospital, patients should explicitly ask about "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full within a short window, bypassing the administrative costs associated with insurance claims processing.