Blood antibody screen
Facility: Nemaha Valley Community Hospital
Billing Code: 86850 (CPT)
- CPT Billing Code: 86850
- Insurance Median: $33
- Cash Discount Price: $57
- vs. Medicare Baseline: 0.62x 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 |
|---|---|---|
| Va Ccn - All Plans | $6 | 11% |
| Humana | $28 | 53% |
| Aetna | $28 - $54 | 53% |
| Celtic Comm Exch - All Plans | $30 | 56% |
| Partners Direct Health - All Plans | $33 | 62% |
| Multiplan - All Plans | $57 | 107% |
| Health Partners - All Plans | $60 | 113% |
| Midlands Choice - All Plans | $60 | 113% |
Consumer Guidance & Cost Commentary
For Nemaha Valley Community Hospital in Seneca, KS, the negotiated rates for a blood antibody screen (CPT 86850) range from $28 to $60, with a median negotiated amount of $33.00. This facility, a Critical Access Hospital, offers a cash-pay price of $57.00, which is notably higher than the median negotiated rate of $33.00. While the cash price is higher than the negotiated rate, patients with high-deductible plans may find paying out-of-pocket cheaper if their insurance allowed amount exceeds the cash price. It is important to note that the cash price here is also higher than the facility's own median paid amount of $54.00, suggesting that the negotiated rates for many payers are more favorable than the cash option.
The facility's pricing is anchored by a Medicare amount of $53.24, which serves as a benchmark for fair value. Commercial negotiated rates generally average between 200% and 300% of Medicare, though fair pricing is typically defined as 120% to 150% of this baseline. In this case, the lowest negotiated rate of $28.00 falls below the Medicare amount, while the highest reaches $60.00. Patients should be aware that balance billing can occur if they receive care from out-of-network providers, but the No Surprises Act protects against surprise bills for emergency and non-emergency services at in-network facilities. To minimize costs, patients should request a prompt-pay discount, which can reduce bills by 20% to 50% when paid upfront, and always demand an item