Blood antibody screen
Facility: Clara Barton Hospital
Billing Code: 86850 (CPT)
- CPT Billing Code: 86850
- Insurance Median: $123
- Cash Discount Price: $96
- vs. Medicare Baseline: 2.31x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 231% of the Medicare baseline (a markup of 131%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Blue Cross Blue Shield | $21 | 39% |
| 6 Degrees Health - All Plans | $96 | 180% |
| Wppa-All Plans | $110 | 207% |
| UnitedHealthcare | $123 | 231% |
| Aetna | $123 | 231% |
| Phcs - All Plans | $123 | 231% |
| Hlth Partners Of Ks-All Plans | $126 | 237% |
Consumer Guidance & Cost Commentary
For the CPT code 86850, "Blood antibody screen," Clara Barton Hospital in Hoisington, KS, has a cash median price of $96.00 and a median negotiated rate of $123.00. While the facility's cash price is lower than its negotiated rates, it is important to note that commercial insurance plans often pay significantly more than the cash price due to administrative costs and contract structures. In this specific case, the cash price of $96.00 is notably lower than the facility's negotiated rate of $123.00, meaning patients with high-deductible plans or those without insurance could potentially save money by paying cash directly. However, patients should verify their specific plan's deductible status and confirm with the hospital whether "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront payment incentives can further reduce the final cost.
The facility's pricing for this service is also contextualized against federal benchmarks. The Medicare amount for this code is $53.24, which serves as a baseline for evaluating the facility's markup. The facility's cash price of $96.00 represents approximately 180% of the Medicare rate, while the negotiated rate of $123.00 is roughly 231% of the Medicare amount. This data suggests that the facility's pricing aligns with typical commercial rate markups, which often range between 200% and 300% of Medicare rates. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but it is crucial to request