Hepatitis C antibody test
Facility: Children'S Mercy South
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $42
- Cash Discount Price: $52
- vs. Medicare Baseline: 2.94x 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 294% of the Medicare baseline (a markup of 194%). 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 |
|---|---|---|
| UnitedHealthcare | $13 - $113 | 91% |
| Healthy Blue | $16 - $39 | 112% |
| Medicaid / KanCare | $17 | 119% |
| Blue Cross Blue Shield | $20 - $124 | 140% |
| Cigna | $23 - $117 | 161% |
| Medica | $28 - $98 | 196% |
| Aetna | $29 - $114 | 203% |
| Health Midwest Comprehensive Care | $31 - $109 | 217% |
| Centivo | $31 - $109 | 217% |
| Wellfit/Centrus | $31 - $109 | 217% |
| Wppa Providrs Care | $31 - $109 | 217% |
| Quiktrip | $31 - $109 | 217% |
| Nebraska Furniture Mart | $31 - $109 | 217% |
| Orscheln | $31 - $109 | 217% |
| Humana | $32 - $112 | 224% |
| Home State Health | $34 | 238% |
| Multiplan | $36 - $128 | 252% |
| Mercy Health | $36 - $126 | 252% |
| Coventry Health Care Of Kansas | $36 - $124 | 252% |
| Coxhealth Network | $36 - $124 | 252% |
| American Healthcare Alliance | $41 - $143 | 287% |
| Healthlink | $42 - $148 | 294% |
| National Preferred Provider Network | $43 - $151 | 301% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Children's Mercy South in Overland Park, KS, the facility's cash median price of $52.00 is significantly lower than the state average for this service. While the gross charge listed is $108.00, patients with high-deductible plans may find the cash price more affordable than their insurance negotiated rates, which range from $13 to $151 across 23 different payers. It is important to note that many commercial payers, including UnitedHealthcare and Blue Cross Blue Shield, have negotiated rates that exceed the cash price, meaning paying out-of-pocket could result in immediate savings. Additionally, the facility offers a negotiated rate of $42.00, which remains below the gross charge but is still higher than the cash option, highlighting the potential benefit of self-pay classification.
When evaluating costs, it is crucial to compare rates against the Medicare benchmark rather than the hospital's gross chargemaster. The Medicare amount for this procedure is $14.27, and the facility's cash rate of $52.00 represents a markup of approximately 2.9 times the Medicare rate. Commercial negotiated rates often average 200% to 300% of Medicare, whereas fair pricing is typically defined as 120% to 150% of this baseline. To minimize costs, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront. Furthermore, patients should request an itemized bill to ensure