Blood antibody screen
Facility: Hiawatha Community Hospital
Billing Code: 86850 (CPT)
- CPT Billing Code: 86850
- Insurance Median: $470
- Cash Discount Price: $603
- vs. Medicare Baseline: 8.83x 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 883% of the Medicare baseline (a markup of 783%). 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 | $87 - $91 | 163% |
| Aetna | $223 - $487 | 419% |
| UnitedHealthcare | $223 - $518 | 419% |
| Humana | $225 | 423% |
| Ambetter / Centene | $268 | 503% |
| Oscar - All Plans | $452 | 849% |
| Centrus Health Direct - All Plans | $452 | 849% |
| Preferred Hlth - All Plans | $543 | 1020% |
| Cigna | $573 | 1076% |
| Wppa Providrs Care - All Plans | $573 | 1076% |
| Midlands Choice - All Plans | $585 | 1099% |
| Multiplan - All Plans | $585 | 1099% |
| Healthy Blue Mcaid - All Plans | $603 | 1133% |
Consumer Guidance & Cost Commentary
For the CPT code 86850 (Blood antibody screen) at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $603.00, which matches the facility's gross charge and the state median cash rate. While the hospital's negotiated rates with insurance plans range from $87 to $603, the median negotiated amount is $452.00, which is lower than the cash price. This suggests that for patients with high-deductible plans, paying the cash price of $603.00 upfront might be more cost-effective than relying on insurance, as the insurer's allowed amount could exceed the cash rate. Patients should verify their specific plan's deductible status and ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full before or shortly after the service.
When evaluating the cost of this service, it is important to compare rates against the Medicare benchmark rather than the hospital's gross charge. The Medicare amount for this code is $53.24, and the facility's cash rate of $603.00 represents a significant markup relative to this federal baseline. Although the facility is a Voluntary non-profit Critical Access Hospital, the wide variation in negotiated rates across different payers—ranging from $87 with Blue Cross Blue Shield to $603 with Healthy Blue Mcaid—highlights that in-network status does not guarantee the lowest price. To ensure you are not overcharged, request an itemized billing audit to confirm that all charges are accurate and that no unbundled codes or