Blood antibody screen
Facility: Ellinwood District Hospital
Billing Code: 86850 (CPT)
- CPT Billing Code: 86850
- Insurance Median: $56
- Cash Discount Price: $68
- vs. Medicare Baseline: 1.05x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| UnitedHealthcare | $56 | 105% |
| Humana | $56 | 105% |
| Aetna | $56 | 105% |
| Cigna | $56 | 105% |
| Blue Cross Blue Shield | $56 | 105% |
Consumer Guidance & Cost Commentary
For the CPT code 86850, representing a blood antibody screen at Ellinwood District Hospital in Ellinwood, KS, the negotiated payment rate is $56.00, which matches the median negotiated rate for this service in the state of Kansas. While the facility's cash price is listed at $68.00, patients with high-deductible plans may find paying out-of-pocket cheaper if their insurance negotiated rate exceeds the cash price, though this specific data point shows the cash rate is higher. It is important to note that while the facility is a Critical Access Hospital owned by a Government Hospital District, the cash price does not necessarily represent the lowest possible cost; patients should always inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can range from 20% to 50% off the billed amount when paid in full upfront.
The Medicare benchmark for this service is $53.24, serving as a scientifically validated baseline for the true cost of care, and the facility's negotiated rate of $56.00 is slightly above this federal standard. This aligns with the general finding that fair pricing is typically defined between 120% and 150% of the Medicare rate, whereas commercial rates often reach 200% to 300%. Because commercial insurance contracts include administrative overhead and volume-based negotiations, the $56.00 rate reflects the specific agreement between the payer and the hospital rather than the full chargemaster list price. Consumers should be aware that balance billing is largely prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, meaning patients