Hepatitis C antibody test
Facility: Phillips County Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $69
- Cash Discount Price: $65
- vs. Medicare Baseline: 4.84x 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 484% of the Medicare baseline (a markup of 384%). 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 | $45 - $62 | 315% |
| UnitedHealthcare | $61 - $76 | 427% |
| Health Partners-All Plans | $76 | 533% |
| Medicaid / KanCare | $76 | 533% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Phillips County Hospital in Phillipsburg, KS, the facility's cash median price of $65.00 is notably lower than the state average, which sits at $69.00. While the hospital's negotiated rates with major payers like Blue Cross Blue Shield and UnitedHealthcare range from $45.00 to $76.00, patients should be aware that cash payments can sometimes result in lower out-of-pocket costs if their insurance deductible has not yet been met. Since the facility is a Critical Access Hospital owned by the local government, it is advisable to explicitly ask for "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can bypass the administrative overhead often embedded in commercial negotiated rates.
When evaluating the cost against federal benchmarks, the Medicare amount for this service is $14.27, which serves as the objective baseline for fair pricing. Although the facility's cash rate of $65.00 exceeds the Medicare rate, it remains significantly below the typical commercial markup seen in many markets, where negotiated rates often average 200% to 300% of the Medicare amount. To ensure you are receiving the best possible price, request a full itemized billing audit to verify that no unbundled codes or services not rendered are included in the final statement. Given that over 80% of hospital bills contain errors, reviewing the line-by-line charges is a critical step in confirming that the facility is charging only for the actual service provided.