Hepatitis C antibody test
Facility: Girard Medical Center
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $81
- Cash Discount Price: $138
- vs. Medicare Baseline: 5.68x 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 568% of the Medicare baseline (a markup of 468%). 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 - $80 | 315% |
| Kansas Superior Select-All Plans | $80 | 561% |
| UnitedHealthcare | $80 - $218 | 561% |
| Aetna | $80 - $402 | 561% |
| Medicare (plans) | $80 | 561% |
| Humana | $80 | 561% |
| Ambetter / Centene | $80 | 561% |
| Multiplan-All Plans | $213 | 1493% |
| Uhhis-All Plans | $218 | 1528% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test at Girard Medical Center, the cash median price is $138, which is notably lower than the negotiated rates charged by major insurers like Aetna (up to $402) and UnitedHealthcare (up to $218). While the facility's cash rate is higher than the state average of $81, it remains significantly lower than the gross chargemaster price of $230. Patients with high-deductible plans or those without insurance may find paying the cash median of $138 more cost-effective than relying on insurance, which often results in higher out-of-pocket costs due to deductibles and co-pays. It is important to note that while the facility is a Critical Access Hospital in Kansas, the negotiated rates for this service vary widely across different payers, with some plans capping payments as low as $45 while others allow up to $402.
To minimize unexpected costs, patients should actively request a prompt-pay discount or self-pay rate before scheduling the test, as these upfront payments can bypass the administrative overhead of insurance billing cycles. Additionally, if you have received a bill from an out-of-network provider or a service that was not covered by your plan, you may be subject to balance billing, where the provider charges the difference between their full rate and what your insurance paid. Under the No Surprises Act, balance billing for emergency care and non-emergency services at in-network facilities is generally prohibited, so any surprise bill should be disputed with your insurer. Finally, always demand a full itemized bill before paying; over 80% of hospital bills contain errors such as double-charging or unbundled codes, and a