Hepatitis C antibody test
Facility: Wamego Health Center
Billing Code: 86803 (CPT)
- CPT Billing Code: 86803
- Insurance Median: $15
- Cash Discount Price: $126
- vs. Medicare Baseline: 1.05x 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 |
|---|---|---|
| UnitedHealthcare | $14 | 98% |
| Providrs Care | $14 | 98% |
| Aetna | $15 | 105% |
| Medicaid / KanCare | $15 | 105% |
| Blue Cross Blue Shield | $268 - $284 | 1878% |
Consumer Guidance & Cost Commentary
For the Hepatitis C antibody test (CPT code 86803) at Wamego Health Center in Wamego, KS, the facility's cash median price of $126.00 is significantly lower than the gross charge of $315.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the negotiated rates for commercial payers like UnitedHealthcare and Aetna range between $14 and $15, which is notably lower than the cash price. This scenario highlights a common billing dynamic where cash-pay options can be more cost-effective for patients with high-deductible plans if the insurance negotiated rate exceeds the cash price. However, patients should verify their specific plan's deductible status before relying on insurance, as paying the full negotiated rate may be required if the deductible has not yet been met.
When comparing this facility's pricing to broader benchmarks, the Medicare amount for this service is $14.27, and the median negotiated rate across payers is $15.00. The facility's cash price of $126.00 represents a substantial markup relative to the Medicare benchmark, which serves as the federal standard for "true cost" of care. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still request a self-pay or prompt-pay discount before scheduling to avoid unexpected costs. To ensure accuracy, consumers are encouraged to review their itemized bill line-by-line to confirm that no unbundled codes or services not rendered have been included, as over 80% of hospital bills contain errors that can be corrected through