CMS Price Transparency Data

Hepatitis C antibody test

Facility: Pawhuska Hospital, Inc

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $119
Cash Discount Price: $94
vs. Medicare Baseline: 8.34x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Pawhuska Hospital, Inc is $119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $94. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 8.34x the Medicare baseline. Located in 1101 East 15Th Street, Pawhuska, OK.

Cash / Self-Pay

$94

Average discount available for prompt cash payment at this facility.

Insurance Median

$119

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: $94 (659%)

Insurance Median: $119 (834%)

Cash: $94 (659% of Medicare)

Ins. Median: $119 (834% 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 834% of the Medicare baseline (a markup of 734%). 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	$23 - $117	161%
Healthchoice Ip/Op Only - All Plans	$24	168%
Community Care Comm - All Plans	$36	252%
Blue Cross Blue Shield	$85 - $138	596%
Aetna	$94 - $162	659%
Tricare	$94	659%
Wellcare Mcr Adv - All Plans	$94	659%
Humana	$95 - $162	666%
Healthcare Highways - All Plans	$105	736%
Cigna	$110	771%
Multiplan - All Plans	$122	855%
Ambetter / Centene	$141	988%
Preferred Commchoice Ip/Op Only - All Plans	$146	1023%
Soonerselect Mcaid - All Plans	$162	1135%

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 $94.
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 Pawhuska Hospital, Inc 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.