Hepatitis C antibody test
Facility: Cloud County Health Center
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $121
- Cash Discount Price: $89
- vs. Medicare Baseline: 8.48x 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 848% of the Medicare baseline (a markup of 748%). 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 | $115 - $118 | 806% |
| Mpi-All Plans | $121 | 848% |
| Health Partners - All Plans | $121 | 848% |
| Pponext-All Plans | $121 | 848% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Cloud County Health Center in Concordia, KS, the facility's cash price of $89.00 is lower than the state average and the negotiated rates paid by major payers like Aetna, Mpi-All Plans, and Health Partners, which average $121.00. While commercial insurance contracts often result in higher allowed amounts due to administrative processing costs, patients with high-deductible plans may find paying the cash price upfront more beneficial, as it avoids the $121.00 amount the insurer would otherwise cover. The facility, a voluntary non-profit Critical Access Hospital, lists a cash median of $89.00, which is notably lower than the Medicare benchmark of $14.27 when adjusted for the specific service context, though the primary comparison here is between the cash rate and the commercial negotiated rate of $121.00.
To ensure you are not overcharged, it is important to understand that hospitals often issue summary bills that obscure individual line items, potentially including unbundled codes or services not rendered. Before finalizing payment, you should request a full itemized CPT-coded bill to verify that charges align with the actual services provided and to identify any errors that could be disputed. Additionally, since the cash price of $89.00 is already lower than the negotiated rate of $121.00, you should contact the billing department directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these programs can further reduce costs for those paying in full upfront.