Blood antibody screen
Facility: Cloud County Health Center
Billing Code: 86850 (CPT)
- CPT Billing Code: 86850
- Insurance Median: $144
- Cash Discount Price: $109
- vs. Medicare Baseline: 2.70x 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 270% of the Medicare baseline (a markup of 170%). 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 |
|---|---|---|
| Aetna | $117 - $200 | 220% |
| Pponext-All Plans | $124 - $204 | 233% |
| Health Partners - All Plans | $124 - $204 | 233% |
| Mpi-All Plans | $124 - $204 | 233% |
Consumer Guidance & Cost Commentary
For the blood antibody screen (CPT 86850) at Cloud County Health Center in Concordia, KS, the facility's cash median price of $109.00 is lower than the state average of $144.00. While the facility's negotiated rate for in-network payers like Aetna and Pponext-All Plans is $144.00, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount exceeds this figure. It is important to note that commercial negotiated rates often include administrative overhead and can be higher than cash prices; therefore, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not paying the full negotiated rate.
This service is benchmarked against Medicare, which sets a fixed reimbursement rate of $53.24 for this procedure. The facility's cash price of $109.00 represents a markup of 2.7 times the Medicare amount, which falls within the typical range where fair pricing is defined as 120% to 150% of Medicare, though commercial rates often average 200% to 300%. If you receive a bill for this service, you should request an itemized billing audit to verify that no unbundled codes or services not rendered have inflated the total, as over 80% of hospital bills contain errors. Additionally, if you are an out-of-network patient, the No Surprises Act may protect you from balance billing for emergency care or non-emergency services at in-network facilities, so you should dispute any unexpected charges immediately rather than accepting summary bills