Hepatitis C antibody test
Facility: Republic County Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $53
- Cash Discount Price: $45
- vs. Medicare Baseline: 3.71x 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 371% of the Medicare baseline (a markup of 271%). 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 |
|---|---|---|
| Rural Carriers-All Plans | $45 - $56 | 315% |
| Aetna | $48 - $59 | 336% |
| Meritain-All Plans | $48 - $59 | 336% |
| UnitedHealthcare | $49 - $61 | 343% |
| Cigna | $50 - $63 | 350% |
| Midlands Choice-All Plans | $50 - $63 | 350% |
| First Health-All Plans | $50 - $63 | 350% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Republic County Hospital in Belleville, KS, the cash price of $45.00 is lower than the facility's negotiated rates with major payers, which range from $45.00 to $63.00. This test is classified as a Critical Access Hospital service, and the facility's cash rate aligns closely with the lowest end of the negotiated spectrum, starting at $45.00 for Rural Carriers and Aetna. While the facility's cash price is slightly above the national Medicare benchmark of $14.27, it remains significantly below the median negotiated amount of $53.00 and the median paid amount of $50.00. Patients with high-deductible plans may find the cash price advantageous, as paying upfront avoids the administrative fees and potential overcharges often associated with insurance processing.
To secure the lowest possible rate, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as billing systems may automatically submit claims to insurance even when a patient intends to pay in full. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to verify that all ancillary services, such as lab draws, are covered under the facility's network agreements to avoid unexpected secondary charges. Given that the facility is a Voluntary non-profit - Private Critical Access Hospital, patients are encouraged to contact the billing department directly to confirm if any additional prompt-pay incentives are available, ensuring they are not charged the full negotiated rate of up to $63.00 by carriers like Cigna or Midlands