Hepatitis C antibody test
Facility: Trego County Lemke Memorial Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $60
- Cash Discount Price: $60
- vs. Medicare Baseline: 4.20x 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 420% of the Medicare baseline (a markup of 320%). 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 |
|---|---|---|
| Va Ccn - All Plans | $10 | 70% |
| Humana | $34 | 238% |
| Tricare | $37 | 259% |
| Aetna | $43 - $63 | 301% |
| Medicaid / KanCare | $43 - $70 | 301% |
| UnitedHealthcare | $43 - $70 | 301% |
| Ambetter / Centene | $48 | 336% |
| Blue Cross Blue Shield | $62 | 434% |
| Health Partners - All Plans | $66 | 463% |
| Healthy Blue Mcaid - All Plans | $70 | 491% |
Consumer Guidance & Cost Commentary
For this Hepatitis C antibody test at Trego County Lemke Memorial Hospital, the cash median price is $60.00, which is lower than the facility's negotiated rates of $60.00 and the gross charge of $70.00. While the facility is a Critical Access Hospital in Wakeeney, KS, with a government-local ownership structure, patients should note that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. If you have a high-deductible plan, paying the $60.00 cash price directly may result in lower out-of-pocket costs compared to your insurance paying their negotiated rate of $60.00 and leaving you responsible for the remaining deductible or copay. Always verify your specific plan's deductible status before scheduling to ensure you are not paying a higher amount than necessary.
To avoid unexpected costs, patients should request a prompt-pay discount if paying in full upfront, which can reduce the bill by 20% to 50% by bypassing insurance claims processing fees. Additionally, if you receive a bill from an out-of-network provider or for services not rendered, you may be eligible for protections under the No Surprises Act, which bans balance billing for emergency care and non-emergency services at in-network facilities. If you receive a summary bill, demand a full itemized CPT-coded statement to identify any errors, double-billing, or unbundled charges before agreeing to pay. Since over 80% of hospital bills contain errors, obtaining a detailed line-by-line audit is the most effective way to reduce medical debt and ensure you are only paying for services actually provided.