Hepatitis C antibody test
Facility: Oakleaf Surgical Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $14
- Cash Discount Price: $243
- vs. Medicare Baseline: 0.98x 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.
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 | $14 | 98% |
| Dean Health Plan | $14 | 98% |
| Group Health Cooperative Of Eau Claire | $14 | 98% |
| Healthpartners | $14 | 98% |
| Humana | $14 | 98% |
| Medica | $14 | 98% |
| Quartz Health Solutions | $14 | 98% |
| Security Health Plan Of Wi | $14 | 98% |
| Ucare Wi | $14 | 98% |
| UnitedHealthcare | $14 | 98% |
Consumer Guidance & Cost Commentary
For this Hepatitis C antibody test at Oakleaf Surgical Hospital in Altoona, WI, the cash median price is $243, which is higher than the state average of $243 and the county average of $243. While the facility lists a gross charge of $270, patients with high-deductible plans might find it beneficial to pay the cash rate of $243 directly, as this amount is lower than the typical negotiated rates of $14 to $14 that commercial payers like Blue Cross Blue Shield and UnitedHealthcare are contractually allowed to pay. It is important to note that commercial negotiated rates can sometimes exceed cash prices due to administrative overhead and contract structures, so self-pay or prompt-pay discounts should be requested directly from the hospital before scheduling to potentially lower the final cost.
The Medicare benchmark for this service is $14.27, which serves as a scientifically validated baseline for evaluating fair pricing, as commercial rates often include significant markups. Although the facility's cash rate of $243 is substantially higher than the Medicare amount of $14.27, patients should be aware that balance billing is largely prohibited for out-of-network services at in-network facilities under the No Surprises Act. If a patient receives an unexpected bill for the difference between the chargemaster and the allowed amount, they should request an itemized billing audit to identify errors or unbundled codes, as over 80% of hospital bills contain mistakes that can be corrected through formal written disputes rather than verbal agreements.