Hepatitis C antibody test
Facility: Susan B Allen Memorial Hospital
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $554
- Cash Discount Price: $46
- vs. Medicare Baseline: 38.82x 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 3882% of the Medicare baseline (a markup of 3782%). 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 | $350 | 2453% |
| Providrs Care | $757 | 5305% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT 86803) at Susan B Allen Memorial Hospital in El Dorado, KS, the cash price is $46.00, which is significantly lower than the facility's gross charge of $71.00. While the hospital's negotiated rate with UnitedHealthcare is $350.00 and with Providrs Care is $757.00, these amounts are often higher than the cash price due to administrative costs and contract structures. It is important to note that for patients with high-deductible plans, paying the cash price of $46.00 upfront can sometimes be more cost-effective than relying on insurance, especially if the insurance negotiated rate exceeds the cash amount. Patients should verify their specific plan details and ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling to ensure they receive the best possible rate.
When evaluating the cost against federal benchmarks, the Medicare amount for this service is $14.27. The facility's cash price of $46.00 represents a 38.8% increase over the Medicare rate, which aligns with the typical range where fair pricing is often defined as 120% to 150% of the Medicare benchmark. Although the data does not provide specific state or county average comparisons for this code, understanding the Medicare baseline helps clarify the true cost of care versus the inflated chargemaster list price. To avoid unexpected costs, patients should request an itemized bill to review every line item and ensure no services were billed that were not rendered, as over 80% of hospital bills contain errors that can be corrected through