Hepatitis C antibody test
Facility: Decatur Health
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $64
- Cash Discount Price: $75
- vs. Medicare Baseline: 4.48x 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 448% of the Medicare baseline (a markup of 348%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $50 | 350% |
| UnitedHealthcare | $51 - $64 | 357% |
| Humana | $52 | 364% |
| Blue Cross Blue Shield | $58 | 406% |
| Aetna | $75 - $84 | 526% |
| Midlands Choice- All Plans | $75 | 526% |
| Medicaid / KanCare | $85 | 596% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Decatur Health in Oberlin, KS, the cash median price is $75.00, which is lower than the facility's negotiated rates for most major payers. While the facility's cash price sits below the gross chargemaster of $84.00, it is important to note that commercial insurance contracts often result in higher allowed amounts; for instance, Aetna's negotiated rate range is $75.00 to $84.00, and UnitedHealthcare's ranges from $51.00 to $64.00. Patients with high-deductible plans may find paying the cash price of $75.00 directly more cost-effective than relying on insurance, which could result in a higher allowed amount that exceeds the cash rate. Additionally, the facility offers a prompt-pay discount for upfront payment, which can further reduce the final bill for self-pay patients.
When evaluating the cost of this service, it is essential to compare the facility's rates against the Medicare benchmark rather than the inflated chargemaster list. The Medicare amount for this code is $14.27, and the facility's cash price of $75.00 represents a significant markup above this federal baseline, which is common in commercial pricing structures. To ensure you are not overcharged, patients should request an itemized billing audit to verify that no unbundled codes or services not rendered are included in the final invoice. Furthermore, if you are receiving care from an out-of-network provider or if ancillary services like emergency physicians are out-of-network, you may be subject to balance billing; however