Hepatitis C antibody test
Facility: Lindsborg Community Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $117
- Cash Discount Price: $89
- vs. Medicare Baseline: 8.20x 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 820% of the Medicare baseline (a markup of 720%). 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 | 315% |
| Tricare | $60 | 420% |
| Coventry Mcr Adv | $60 | 420% |
| Cigna | $108 | 757% |
| UnitedHealthcare | $115 | 806% |
| Coventry Comm-All Other Plans | $115 | 806% |
| Phcs Preferred-All Plans | $118 | 827% |
| Multiplan-All Plans | $118 | 827% |
| Century Health-All Plans | $121 | 848% |
| Wppa-All Plans | $121 | 848% |
| Coventry Wc | $121 | 848% |
| Health Partners -All Plans | $121 | 848% |
Consumer Guidance & Cost Commentary
For this Hepatitis C antibody test at Lindsborg Community Hospital, the cash price of $89.00 is lower than the facility's negotiated rates, which range from $45.00 to $121.00 depending on the insurance carrier. While the cash price is competitive, it is important to note that many commercial payers, such as UnitedHealthcare and Coventry, have negotiated rates exceeding the cash amount. In cases where your insurance deductible has not yet been met, paying the cash price of $89.00 upfront can be more cost-effective than your insurer paying a higher negotiated rate and then requiring you to cover the difference. Patients should always verify their specific plan's deductible status and ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can significantly reduce the final cost.
The facility's cash rate of $89.00 is notably lower than the Medicare benchmark of $14.27 when adjusted for the specific context of this service, though the provided data indicates a comparison metric of 8.2% relative to Medicare. It is crucial to understand that commercial negotiated rates often include administrative overhead and contract structures that can inflate the baseline price compared to the federal government's cost-based reimbursement. If you receive a bill that includes charges for out-of-network services at this in-network facility, the No Surprises Act protects you from balance billing for emergency care and non-emergency services. To ensure accuracy, always request a full itemized bill before making any payments, as summary bills may obscure individual line items or unbundled codes that could be disputed.