Hepatitis C antibody test
Facility: Sheridan County Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $62
- Cash Discount Price: $91
- 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 |
|---|---|---|
| Celtic Insurance | $55 | 385% |
| Blue Cross Blue Shield | $62 | 434% |
| UnitedHealthcare | $86 | 603% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test at Sheridan County Hospital in Hoxie, KS, the cash price is $91.00, which matches the facility's median negotiated rate of $62.00 for in-network payers like Celtic Insurance and Blue Cross Blue Shield. While the facility is a Critical Access Hospital with government-local ownership, the cash price is notably higher than the state average for this service. Because the cash price exceeds the negotiated rates for most major payers, patients with high-deductible plans may find it more cost-effective to pay out-of-pocket upfront rather than relying on insurance, which could result in higher out-of-pocket costs after deductibles are met. We recommend contacting the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these programs can reduce the final bill by 20% to 50% if paid in full before or shortly after the service.
When reviewing your bill, it is important to distinguish between the facility's gross charge of $91.00 and the actual amount your insurance will allow. Although the No Surprises Act protects patients from balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, unexpected charges can still occur if ancillary services like lab tests are billed by out-of-network providers. If you receive a bill that seems higher than expected, request a formal itemized audit to verify that no unbundled codes or services not rendered have been included. Finally, compare the facility's Medicare benchmark rate of $14.27 to your commercial rates; while commercial rates often run 200% to 300% of Medicare, fair pricing is typically defined