CMS Price Transparency Data

Blood antibody screen

Facility: Madison County Health Care System

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $90
Cash Discount Price: $80
vs. Medicare Baseline: 1.69x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Madison County Health Care System is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 1.69x the Medicare baseline. Located in 300 West Hutchings Street, Winterset, IA.

Cash / Self-Pay

$80

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $80 (150%)

Insurance Median: $90 (169%)

Cash: $80 (150% of Medicare)

Ins. Median: $90 (169% 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
Aetna	$43 - $65	81%
Medical Associates Hp - All Plans	$43	81%
Medigold-All Plans	$43	81%
Tricare	$43	81%
UnitedHealthcare	$43 - $90	81%
American Hp Mcr Adv-All Plans	$45	85%
Iowa Total Care Mcaid-All Plans	$47	88%
Molina Mcaid/Chip -All Plans	$49	92%
Amerigroup Mcaid-All Plans	$50	94%
Madison County Sheriff-All Plans	$50	94%
Oscar - All Plans	$64	120%
Corvel Wc-All Plans	$90	169%
Choicecare-All Plans	$95	178%
First Choice-All Plans	$95	178%
First Health-All Plans	$95	178%
Integrated Hp-All Plans	$95	178%
Mutual Of Omaha-All Plans	$95	178%
Plaines Health-All Plans	$95	178%
Preferred Hlth Ntwork-All Plans	$95	178%
Principal Healthcare-All Plans	$95	178%
Usa Managed Care-All Plans	$95	178%
Blue Cross Blue Shield	$97 - $107	182%
Medimore Employee Hp - All Plans	$98	184%
Midlands Choice - All Plans	$98	184%
Benefit Admin Of America-All Plans	$100	188%

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 $80.
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 Madison County Health Care System 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.