Hepatitis C antibody test
Facility: William Newton Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $50
- Cash Discount Price: $118
- vs. Medicare Baseline: 3.50x 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 350% of the Medicare baseline (a markup of 250%). 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 |
|---|---|---|
| Ambetter / Centene | $11 - $175 | 77% |
| UnitedHealthcare | $13 - $158 | 91% |
| Blue Cross Blue Shield | $14 - $63 | 98% |
| Triwest- All Plans | $14 - $61 | 98% |
| Providrs Care Nexus | $58 - $107 | 406% |
| Providrs Care - All Other Plans | $66 - $122 | 463% |
Consumer Guidance & Cost Commentary
For this Hepatitis C antibody test at William Newton Hospital in Winfield, KS, the cash price is $118.00, which matches the facility's median negotiated rate of $54.00 when compared directly to the cash median. While the facility is a Critical Access Hospital with a government-local ownership structure, patients should note that commercial insurance negotiated rates for this service range widely among payers, from a low of $11 to a high of $175. Because commercial rates often include administrative overhead and contract markups, paying cash upfront can sometimes be more cost-effective than relying on insurance, especially for patients with high deductibles where the insurer's allowed amount might exceed the cash price.
To ensure you are not overcharged, it is crucial to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, since the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, you should verify that all components of your care are covered under your plan's network agreements. Finally, always ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce your bill by 20% to 50% if you settle the account in full within a short window, bypassing the costly claims processing cycle that inflates insurance rates.