CMS Price Transparency Data

Blood antibody screen

Facility: Spencer Municipal Hospital

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $59
Cash Discount Price: $52
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Spencer Municipal Hospital is $59. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $52. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 1.11x the Medicare baseline. Located in 1200 1St Avenue East, Spencer, IA.

Cash / Self-Pay

$52

Average discount available for prompt cash payment at this facility.

Insurance Median

$59

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$53.24

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $53.24 (100%)

Cash / Self-Pay: $52 (98%)

Insurance Median: $59 (111%)

Cash: $52 (98% of Medicare)

Ins. Median: $59 (111% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $53.24 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
Wellmark Hmo	$36	68%
Wellmark Ppo	$39	73%
Humana	$44 - $66	83%
Medicare (plans)	$44	83%
UnitedHealthcare	$44 - $62	83%
Medicaid / KanCare	$49	92%
Healthpartners (All)	$55	103%
Midlands Choice - Ilcc	$59	111%
Midlands Choice - Morton Bldg	$59	111%
Coventry - Commercial Hmo	$62	116%
Avera Health Plan	$66	124%
Coventry - Commercial Ppo	$66	124%
First Choice Of Midwest	$66	124%
Midlands Choice (All Others)	$66	124%
Sanford Health	$66	124%

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 $52.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 86850.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Spencer Municipal Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 86850.
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.