CMS Price Transparency Data

Hepatitis C antibody test

Facility: Community Memorial Hospital

Billing Code: 86803 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86803
  • Insurance Median: $205
  • Cash Discount Price: $163
  • vs. Medicare Baseline: 14.37x Medicare
The contracted insurance negotiated median rate for a Hepatitis C antibody test at Community Memorial Hospital is $205. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $163. Compared to the federal Medicare reimbursement reference rate of $14.27, this hospital’s rate is 14.37x the Medicare baseline. Located in W180 N8085 Town Hall Rd, Menomonee Falls, WI.
Cash / Self-Pay
$163

Average discount available for prompt cash payment at this facility.

Insurance Median
$205

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: $163 (1142%)
Insurance Median: $205 (1437%)
Cash: $163 (1142% of Medicare)
Ins. Median: $205 (1437% 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 1437% of the Medicare baseline (a markup of 1337%). 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.

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
Allwell $14 98%
Blue Cross Blue Shield $14 - $71 98%
Community Care $14 98%
Health Partners $14 - $193 98%
Humana $14 98%
Icare $14 98%
Network Health Plan $14 - $17 98%
Security Health Plan $14 98%
UnitedHealthcare $14 - $98 98%
Aetna $15 - $208 105%
Care Wisconsin/Mychoice $15 105%
Sheboygan Employers Health Network $17 119%
Centivo $89 - $98 624%
Froedtert South $125 876%
Chorus Community Health Plan $128 897%
Common Ground $178 1247%
Trilogy $205 1437%
Health Payment Systems $207 1451%
Wisconsin Physician Services $208 1458%
Aspirus $238 1668%
Ibsi Passport $241 1689%
Americas Choice $258 1808%
Federated Mutual $258 1808%
Healtheos $258 1808%
Multiplan/Private Healthcare Systems $258 1808%
Savility $258 1808%
Cigna $261 1829%
First Health Network $261 1829%
Healthsmart $267 1871%
Physicians Plus $267 1871%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: W180 N8085 Town Hall Rd, Menomonee Falls, WI 53051
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals