CMS Price Transparency Data

Blood antibody screen

Facility: Unity Physicians Hospital

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $5,720
Cash Discount Price: Unavailable
vs. Medicare Baseline: 107.44x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Unity Physicians Hospital is $5,720. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 107.44x the Medicare baseline. Located in 4455 Edison Lakes Pkwy, Mishawaka, IN.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,720

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%)

Insurance Median: $5,720 (10744%)

Ins. Median: $5,720 (10744% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 10744% of the Medicare baseline (a markup of 10644%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$5 - $17,574	9%
Medicaid / KanCare	$5	9%
Mhs Hoosier Care Connect	$5	9%
Aarp Supplemental	$44 - $11,325	83%
Aetna	$44 - $11,325	83%
Cigna	$44 - $11,325	83%
Department Of Va	$44 - $11,325	83%
Medicare (plans)	$44 - $11,325	83%
Mhs Healthy Indiana Plan	$44 - $11,325	83%
Railroad Retirement	$44 - $11,325	83%
UnitedHealthcare	$44 - $23,749	83%
Three Rivers Provider Network	$53 - $13,590	100%
Humana	$62 - $21,000	116%
Encore	$80 - $20,386	150%
Nalc	$86 - $23,749	162%
Sagamore Health Network	$86 - $23,749	162%
Provider Network Of America	$89 - $22,651	167%
Multiplan	$94	177%
Multiplan Wc	$115	216%
All Savers	$23,749	44607%
Medica	$23,749	44607%
Medica Ifb	$23,749	44607%
Oxford	$23,749	44607%

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 $X.
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 Unity Physicians 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.