CMS Price Transparency Data

Hepatitis C antibody test

Facility: Fort Memorial Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86803
Insurance Median: $18
Cash Discount Price: $48
vs. Medicare Baseline: 1.26x Medicare

The contracted insurance negotiated median rate for a Hepatitis C antibody test at Fort Memorial Hospital is $18. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $48. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 1.26x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$48

Average discount available for prompt cash payment at this facility.

Insurance Median

$18

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: $48 (336%)

Insurance Median: $18 (126%)

Cash: $48 (336% of Medicare)

Ins. Median: $18 (126% 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.

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
Blue Cross Blue Shield	$4 - $18	28%
Dean Health Plan	$4 - $126	28%
Managed Health Services	$4	28%
Medicaid / KanCare	$4	28%
Quartz	$4 - $81	28%
UnitedHealthcare	$4 - $25	28%
Molina	$11	77%
Humana	$14	98%
Centivo	$17 - $18	119%
Veteran Evaluation Services	$18	126%
Aetna	$60 - $111	420%
Group Health Cooperative	$96 - $252	673%
Alliance	$106	743%
Mercycare	$110	771%
Trilogy	$130	911%
Cigna	$141	988%

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 $48.
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 Fort Memorial 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.