CMS Price Transparency Data

Hepatitis C antibody test

Facility: The Children's Mercy Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $42
Cash Discount Price: $52
vs. Medicare Baseline: 2.94x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at The Children's Mercy Hospital is $42. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $52. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 2.94x the Medicare baseline. Located in 2401 Gillham Road, Kansas City, MO.

Cash / Self-Pay

$52

Average discount available for prompt cash payment at this facility.

Insurance Median

$42

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14.27

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14.27 (100%)

Cash / Self-Pay: $52 (364%)

Insurance Median: $42 (294%)

Cash: $52 (364% of Medicare)

Ins. Median: $42 (294% of 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.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$15 - $113	105%
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%
Centivo	$31 - $109	217%
Health Midwest Comprehensive Care	$31 - $109	217%
Nebraska Furniture Mart	$31 - $109	217%
Orscheln	$31 - $109	217%
Quiktrip	$31 - $109	217%
Wellfit/Centrus	$31 - $109	217%
Wppa Providrs Care	$31 - $109	217%
Humana	$32 - $112	224%
Home State Health	$34	238%
Coventry Health Care Of Kansas	$36 - $124	252%
Coxhealth Network	$36 - $124	252%
Mercy Health	$36 - $126	252%
Multiplan	$36 - $128	252%
American Healthcare Alliance	$41 - $143	287%
Healthlink	$42 - $148	294%
National Preferred Provider Network	$43 - $151	301%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $52.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 86803.

Insurance In-Network Protection Plan

Contact your insurance company to confirm The Children's Mercy Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 86803.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.