Hepatitis C antibody test
Facility: Neosho Memorial Regional Medical Center
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $72
- Cash Discount Price: $169
- vs. Medicare Baseline: 5.05x 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 505% of the Medicare baseline (a markup of 405%). 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 |
|---|---|---|
| Medicaid / KanCare | $14 | 98% |
| Blue Cross Blue Shield | $50 - $72 | 350% |
| Tricare | $69 | 484% |
| Humana | $72 | 505% |
| Medadv_Uhc | $72 | 505% |
| Aetna | $72 | 505% |
| Va_Ccn | $72 | 505% |
| Medadv_Allwell | $72 | 505% |
| Medicare (plans) | $72 | 505% |
| Ambetter / Centene | $76 | 533% |
| United | $187 | 1310% |
| Wppa_Providrscare | $187 | 1310% |
| Cigna | $214 | 1500% |
| Coventry | $214 | 1500% |
| Hpk | $214 | 1500% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Neosho Memorial Regional Medical Center in Chanute, KS, the facility's negotiated rates with major insurers like United, Cigna, and Coventry range from $187 to $214, which are significantly higher than the facility's cash price of $169. While the facility is a Critical Access Hospital with government ownership, these commercial rates exceed the state average for this service. Patients with high-deductible plans may find it financially advantageous to pay the cash price of $169 directly, as this amount is lower than the negotiated rates many commercial payers accept. To maximize savings, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees.
The facility's Medicare allowed amount for this procedure is $14.27, which serves as a critical benchmark for evaluating the facility's pricing markup. Commercial negotiated rates for this test are approximately 1,500% of the Medicare rate, indicating a substantial difference between the federal cost baseline and commercial pricing. Because the No Surprises Act prohibits balance billing for out-of-network services at in-network facilities, patients should be cautious about signing consent waivers that might inadvertently allow for unexpected charges. If a patient receives a bill that appears to include balance billing, they should request a formal itemized audit to verify that all charges correspond to services rendered and that no unbundled codes or duplicate billing occurred.