Hepatitis C antibody test
Facility: Smith County Memorial Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $65
- Cash Discount Price: $69
- vs. Medicare Baseline: 4.56x 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 456% of the Medicare baseline (a markup of 356%). 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% |
| Medicaid / KanCare | $48 - $69 | 336% |
| Multiplan-All Plans | $62 | 434% |
| Wppa-All Plans | $65 | 456% |
| UnitedHealthcare | $66 | 463% |
| Midlands Choice-All Plans | $66 | 463% |
| Health Partners Of Ks Ppo-All Plans | $66 | 463% |
Consumer Guidance & Cost Commentary
Smith County Memorial Hospital's Hepatitis C antibody test (CPT 86803) has a cash price of $69.00, which matches the facility's gross charge and the state average. While Medicaid / KanCare plans negotiate a lower rate of $45.00, commercial payers like Blue Cross Blue Shield and Multiplan-All Plans pay the full $69.00. Because the cash price is identical to the negotiated rate for most commercial insurers, patients with high-deductible plans may find paying out-of-pocket the most cost-effective option, avoiding potential deductibles or copays. However, patients should always verify their specific plan's allowed amount and ask the hospital directly about "self-pay" or "prompt-pay" discounts, as these can further reduce the final cost.
For patients relying on insurance, it is important to understand that the facility's negotiated rates are set by contracts rather than the patient's individual plan, meaning the allowed amount is fixed regardless of whether the patient has met their deductible. If a patient receives out-of-network care at this facility, they could face balance billing for the difference between the facility's chargemaster and the insurance payment, though the No Surprises Act protects against this for emergency services and non-emergency care at in-network facilities. To ensure accuracy, patients should request a full itemized bill before paying, as summary bills often hide unbundled charges or services not rendered, and they should dispute any errors in writing rather than accepting verbal assurances.