Hepatitis C antibody test
Facility: Community Memorial Healthcare, Inc.
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $50
- Cash Discount Price: $90
- vs. Medicare Baseline: 3.50x 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 350% of the Medicare baseline (a markup of 250%). 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 |
|---|---|---|
| Aetna | $32 - $79 | 224% |
| UnitedHealthcare | $40 - $60 | 280% |
| Blue Cross Blue Shield | $45 | 315% |
Consumer Guidance & Cost Commentary
For this Hepatitis C antibody test at Community Memorial Healthcare, Inc. in Marysville, KS, the cash price is $90.00, which matches the facility's median negotiated rate of $50.00 and the state average of $90.00. While the facility's median negotiated rate is lower than the cash price, patients with high-deductible plans may find paying out-of-pocket at the cash rate of $90.00 more cost-effective than relying on insurance, as the insurer's allowed amount often exceeds the cash price. It is important to note that the facility's cash rate is significantly higher than the Medicare benchmark of $14.27, illustrating how commercial rates can be marked up well above the federal cost baseline.
Patients should be aware that insurance companies typically pay less than the full cash price due to administrative costs and contract dynamics; in this case, the median paid amount by insurers is $68.00. To minimize costs, individuals should contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront. If a balance bill arises from an out-of-network service, such as a lab test, the No Surprises Act may protect patients from paying the difference between the insurer's allowed amount and the full chargemaster rate. Always request a detailed, itemized bill before paying to ensure no errors or unbundled charges are included, as over 80% of hospital bills contain discrepancies that can be corrected through a formal audit.