Hepatitis C antibody test
Facility: Goodland Regional Medical Center
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $101
- Cash Discount Price: $101
- vs. Medicare Baseline: 7.08x 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 708% of the Medicare baseline (a markup of 608%). 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% |
| Wppa | $95 - $101 | 666% |
| UnitedHealthcare | $101 | 708% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Goodland Regional Medical Center in Goodland, Kansas, the cash median price is $101.00, which is significantly lower than the facility's negotiated rates of $101.00 to $101.00 for Wppa and UnitedHealthcare, and $45.00 for Blue Cross Blue Shield. While the facility is a Critical Access Hospital with a government-local ownership structure, patients should be aware that cash-pay options can sometimes be more cost-effective than insurance claims, particularly if a patient has a high deductible or if the insurance negotiated rate exceeds the cash price. It is important to verify the specific "self-pay" or "prompt-pay" discounts available directly with the hospital before scheduling, as these upfront incentives can bypass the administrative costs and higher negotiated rates often associated with commercial insurance billing.
This service is priced at 7.1% above the Medicare benchmark of $14.27, illustrating how commercial rates can vary significantly from federal cost baselines. Although the data does not provide specific county or state average comparisons for this procedure, the facility's pricing structure highlights the importance of understanding balance billing risks and itemized billing audits. Patients should avoid accepting summary bills that obscure individual charges and instead request a detailed, line-by-line statement to identify any unbundled codes or services not rendered. Furthermore, if a patient encounters a balance bill from an out-of-network provider, they should not pay immediately out of fear of credit damage but should instead dispute the bill with their insurer and request a No Surprises Act audit to ensure they are not liable for unexpected costs.