Blood antibody screen
Facility: Rooks County Health Center
Billing Code: 86850 (CPT)
- CPT Billing Code: 86850
- Insurance Median: $85
- Cash Discount Price: $71
- vs. Medicare Baseline: 1.60x 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 |
|---|---|---|
| Tricare | $44 | 83% |
| Celtic Mcr Adv | $44 | 83% |
| Veterans Admin - All Plans | $44 | 83% |
| Celtic Comm - All Other Plans | $49 | 92% |
| Aetna | $85 | 160% |
| UnitedHealthcare | $85 | 160% |
| Preferred Benefits Admin | $85 | 160% |
| Health Partners - All Plans | $90 | 169% |
| Preferred Hlthcare - All Other Plans | $90 | 169% |
| Blue Cross Blue Shield | $91 | 171% |
| Healthy Blue Mcaid - All Plans | $94 | 177% |
Consumer Guidance & Cost Commentary
For the CPT code 86850, representing a blood antibody screen, the facility's cash median rate of $71.00 is notably higher than the state average of $49.00, though it remains below the gross charge of $95.00. While commercial payers like Aetna and UnitedHealthcare negotiate rates of $85.00, which exceed the cash price, patients with high-deductible plans may find paying out-of-pocket cheaper if their insurance allowed amount surpasses the cash rate. It is important to note that the facility, a Critical Access Hospital in Plainville, KS, offers a prompt-pay discount for upfront payment, which can reduce the final balance by 20% to 50% and bypass costly administrative processing fees typically associated with insurance claims.
The Medicare benchmark for this service is $53.24, providing a clear baseline for evaluating the facility's pricing structure. Although the facility's negotiated rate of $85.00 is higher than the Medicare amount, this markup reflects the administrative costs and contract dynamics inherent in commercial insurance billing. Consumers should request an itemized billing audit to ensure no unbundled codes or services not rendered are included in the final invoice, as over 80% of hospital bills contain errors. Additionally, if you are out-of-network, the No Surprises Act protects you from balance billing for emergency care and non-emergency services at in-network facilities, so you should dispute any surprise bills rather than paying them immediately.