Hepatitis C antibody test
Facility: Memorial Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $70
- Cash Discount Price: $127
- vs. Medicare Baseline: 4.91x 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 491% of the Medicare baseline (a markup of 391%). 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 | $32 | 224% |
| Humana | $64 | 448% |
| Medicare (plans) | $64 | 448% |
| Tricare | $64 | 448% |
| Ambetter / Centene | $70 | 491% |
| Coventry - All Other Plans | $115 | 806% |
| Health Partners Of Kansas - All Plans | $121 | 848% |
| Preferred Healthcare-All Plans | $121 | 848% |
| Wppa/Providers Care-All Plans | $178 | 1247% |
Consumer Guidance & Cost Commentary
For this Hepatitis C antibody test at Memorial Hospital in Abilene, KS, the cash price is $127.00, which matches the facility's median negotiated rate of $70.00 for most major payers. While the hospital is a Critical Access Hospital with a government ownership structure, the cash price of $127.00 is notably higher than the median negotiated rate of $70.00 paid by insurers like Blue Cross Blue Shield, Humana, and Medicare. This discrepancy highlights that for patients with high-deductible plans, paying cash upfront might be more cost-effective than relying on insurance, as the insurer's allowed amount often exceeds the cash price. Patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can significantly lower the final cost by bypassing administrative claim processing fees.
The facility's pricing is benchmarked against federal standards, where the Medicare rate for this service is $14.27. The commercial negotiated rates range from $32.00 to $178.00 depending on the specific insurance plan, with the lowest negotiated rate being $32.00 and the highest at $178.00. Because the No Surprises Act prohibits balance billing for out-of-network services at in-network facilities, patients can expect the hospital to adhere to these negotiated caps rather than charging the full chargemaster list price. However, to ensure accuracy, patients should request a detailed, itemized bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. Disput