Hepatitis C antibody test
Facility: Fredonia Regional Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $71
- Cash Discount Price: $79
- vs. Medicare Baseline: 4.98x 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 498% of the Medicare baseline (a markup of 398%). 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 | $11 - $71 | 77% |
| Blue Cross Blue Shield | $39 - $45 | 273% |
| Aetna | $40 - $71 | 280% |
| Veterans Programs - All Plans | $40 | 280% |
| Reserve National-All Plans | $71 | 498% |
| Cigna | $71 | 498% |
| Meritain-All Plans | $71 | 498% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Fredonia Regional Hospital in Kansas, the cash price is $79.00, which matches the facility's negotiated rate of $71.00 and the median paid amount of $44.00. This cash price is significantly higher than the Medicare benchmark of $14.27, indicating a substantial markup relative to the federal cost baseline. While the facility is a Critical Access Hospital with government local ownership, patients should note that commercial insurance negotiated rates for this service range widely across payers, from $11 to $71, depending on the specific plan. In cases where a patient's insurance deductible has not yet been met, paying the cash price of $79.00 upfront may be more cost-effective than incurring the full negotiated rate, which could otherwise exceed the cash amount before any insurance benefits apply.
To minimize out-of-pocket costs, patients should proactively contact the hospital's billing department to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full before or shortly after the service. It is also important to request a detailed, itemized bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be disputed. Since the No Surprises Act prohibits balance billing for out-of-network services at in-network facilities, patients can confidently dispute any unexpected charges without fear of credit damage. Finally, when evaluating the value of this test, consumers should compare the facility's rates against the Medicare benchmark rather than the hospital