Hepatitis C antibody test
Facility: St Luke Hospital & Living Center
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $79
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 5.54x 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 554% of the Medicare baseline (a markup of 454%). 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 |
|---|---|---|
| Kansas Department Of Health And Environment | $79 | 554% |
| Ambetter / Centene | $79 | 554% |
| Humana | $79 | 554% |
| Va Ccn | $79 | 554% |
| UnitedHealthcare | $79 | 554% |
| Bluestem Pace | $79 | 554% |
| Blue Cross Blue Shield | $79 | 554% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at St Luke Hospital & Living Center in Marion, KS, the facility's negotiated rate of $79.00 aligns exactly with the lowest and highest negotiated amounts reported across all seven payers, including major carriers like Humana and UnitedHealthcare. This rate is significantly lower than the gross charge of $154.00, reflecting the standard commercial discount structure where in-network contracts cap costs well below the hospital's list price. While the facility is a Critical Access Hospital owned by a government authority, the data does not provide a specific cash-pay or median paid amount for this service, so patients cannot yet determine if paying out-of-pocket would result in a lower total cost.
When evaluating the financial impact of this service, it is important to note that the Medicare benchmark amount for this code is $14.27. Commercial negotiated rates, such as the $79.00 observed here, typically range between 200% and 300% of the Medicare rate, which is a common industry standard for shoppable services. Because the facility's negotiated rate is already at the floor of the payer range, there is no evidence of underpayment relative to the state or county averages for this specific code. Patients should verify their specific plan details, as some high-deductible plans might find the cash price more favorable if the insurance negotiated rate exceeds the cash price, though current data indicates the negotiated rate is the primary benchmark for in-network coverage.