Hepatitis C antibody test
Facility: Clay County Medical Center
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $36
- Cash Discount Price: $38
- vs. Medicare Baseline: 2.52x 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 252% of the Medicare baseline (a markup of 152%). 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 |
|---|---|---|
| Health Partners - All Plans | $7 - $63 | 49% |
| Aetna | $7 - $61 | 49% |
| Wppa/Providrs Care- All Plans | $7 - $61 | 49% |
| UnitedHealthcare | $7 - $63 | 49% |
| Multiplan- All Plans | $7 - $63 | 49% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Clay County Medical Center in Clay Center, KS, the facility's cash median price is $38.00, which matches the gross charge listed. This cash rate is notably lower than the state and county averages, where the median negotiated rate across five payers ranges from $35.00 to $36.00. While the facility is a Critical Access Hospital owned by the local government, patients with high-deductible plans may find the cash price advantageous if their insurance negotiated rates exceed $38.00. To secure this lower amount, patients should explicitly request a "self-pay" classification and ask about "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing costly insurance claims processing.
It is important to note that the facility's cash rate of $38.00 is slightly higher than the median paid amount of $35.00 reported for this service, suggesting that some insurance plans may negotiate rates closer to the cash price. However, patients should be cautious of balance billing if they receive care from out-of-network providers, as the No Surprises Act protects against unexpected bills for emergency services at in-network facilities. If a patient receives an itemized bill, they should request a full line-by-line audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors. Comparing this service to the Medicare benchmark of $14.27 reveals a significant markup, highlighting that commercial rates often include administrative overhead that cash payments avoid.