CMS Price Transparency Data

Blood antibody screen

Facility: Hamilton Memorial Hospital

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $105
Cash Discount Price: $113
vs. Medicare Baseline: 1.97x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Hamilton Memorial Hospital is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $113. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 1.97x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$113

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

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: $113 (212%)

Insurance Median: $105 (197%)

Cash: $113 (212% of Medicare)

Ins. Median: $105 (197% 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
Medicaid / KanCare	$45 - $58	85%
Blue Cross Blue Shield	$46 - $132	86%
Aetna	$49 - $130	92%
Health Alliance	$49 - $116	92%
Humana	$49 - $58	92%
Medicare (plans)	$49 - $58	92%
UnitedHealthcare	$49 - $104	92%
Wellcare	$49 - $58	92%
Alliance Coal	$85 - $102	160%
Healthscope	$85 - $102	160%
Wellfirst (Ssmhic)	$85 - $102	160%
Hope Trust	$91 - $109	171%
Cigna	$96 - $114	180%
Hfn, Inc	$97 - $130	182%
Healthlink	$104 - $130	195%
Multiplan	$104 - $123	195%
Siho	$110 - $130	207%
Three Rivers Provider	$110 - $130	207%
Healthsmart	$116 - $138	218%
Stratose	$116 - $138	218%

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 $113.
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 Hamilton Memorial 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.