Hepatitis C antibody test
Facility: Minneola District Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $57
- Cash Discount Price: $46
- vs. Medicare Baseline: 3.99x 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 399% of the Medicare baseline (a markup of 299%). 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 |
|---|---|---|
| UnitedHealthcare | $40 - $70 | 280% |
| Va Community Care Program-All Plans | $40 - $47 | 280% |
| Humana | $40 - $47 | 280% |
| Blue Cross Blue Shield | $45 | 315% |
| Corporate Plan Management-All Plans | $51 - $60 | 357% |
| Providrs Care Network-All Plans | $51 - $60 | 357% |
| Triwest-All Plans | $54 - $63 | 378% |
| Preferred Health Care (Coventry)-All Other Plans | $54 - $63 | 378% |
| Health Partners Of Kansas-All Plans | $57 - $66 | 399% |
| Aetna | $57 - $70 | 399% |
| Phc (Coventry) Leased Network | $57 - $66 | 399% |
| Medicaid / KanCare | $60 - $70 | 420% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Minneola District Hospital, the cash median price is $46.00, which is lower than the facility's negotiated rate of $57.00. While the facility is a Critical Access Hospital in Kansas, the data does not provide specific county or state average rates for this procedure, so a direct comparison to regional benchmarks is not available in this report. However, the facility's cash price remains below its own negotiated amount, illustrating that paying out-of-pocket can sometimes result in a lower total cost than using insurance, particularly for patients with high-deductible plans where the insurer's allowed amount might exceed the cash price.
When using insurance, the allowed amount varies significantly by payer, ranging from $40 to $70, with the median negotiated rate set at $57.00. This rate is notably higher than the Medicare benchmark of $14.27, which serves as the federal baseline for evaluating hospital pricing markups. Commercial rates often average 200% to 300% of Medicare, whereas fair pricing is typically defined as 120% to 150% of the Medicare rate. Patients should verify their specific plan's allowed amount before scheduling and consider asking the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront. Additionally, since the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients should ensure they receive an itemized bill to confirm no unexpected charges are included.