Hepatitis C antibody test
Facility: Hodgeman County Health Center
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $83
- Cash Discount Price: $94
- vs. Medicare Baseline: 5.82x 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 582% of the Medicare baseline (a markup of 482%). 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 | $43 - $45 | 301% |
| Medicaid / KanCare | $76 - $118 | 533% |
| Triwest - All Plans | $76 | 533% |
| UnitedHealthcare | $76 - $112 | 533% |
| Humana | $76 | 533% |
| Aetna | $94 | 659% |
| First Health - All Plans | $106 | 743% |
| Health Partners - All Plans | $112 | 785% |
| Wppa (Provdrscare) - All Plans | $112 | 785% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Hodgeman County Health Center in Jetmore, KS, the cash median price is $94.00, which is notably lower than the facility's negotiated rates with major payers like Blue Cross Blue Shield ($43–$45) and UnitedHealthcare ($76–$112). While the cash price is competitive, patients with high-deductible plans may find it beneficial to pay the $94.00 cash median directly, as this avoids the administrative overhead and potential markups embedded in insurance negotiated rates that often exceed 200% of the Medicare benchmark of $14.27. To secure the lowest possible cost, patients should explicitly ask the facility about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the costly claims processing cycle that inflates commercial rates.
It is important to distinguish between the facility's gross charge of $118.00 and the actual amounts paid by insurers, which range from $43 to $112 depending on the plan. The Medicare benchmark of $14.27 serves as a critical baseline for evaluating pricing fairness, revealing that commercial negotiated rates are significantly higher than the federal cost basis. If a patient receives an itemized bill that includes unexpected charges or uses a summary bill to obscure individual line items, they should request a full, CPT-coded audit to identify errors such as code unbundling or services not rendered. Given that over 80% of hospital bills contain errors, obtaining a detailed statement before paying