Blood antibody screen
Facility: Decatur Health
Billing Code: 86850 (CPT)
- CPT Billing Code: 86850
- Insurance Median: $108
- Cash Discount Price: $110
- vs. Medicare Baseline: 2.03x 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 203% of the Medicare baseline (a markup of 103%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $73 | 137% |
| UnitedHealthcare | $74 - $93 | 139% |
| Humana | $75 | 141% |
| Blue Cross Blue Shield | $108 | 203% |
| Midlands Choice- All Plans | $110 | 207% |
| Aetna | $110 - $122 | 207% |
| Medicaid / KanCare | $123 | 231% |
Consumer Guidance & Cost Commentary
For the blood antibody screen (CPT 86850) at Decatur Health in Oberlin, Kansas, the facility's cash price of $110.00 is notably lower than the state average of $122.00. While the facility's negotiated rates with major payers like UnitedHealthcare and Aetna range from $74 to $122, the cash price offers a distinct advantage for patients with high-deductible plans or those without insurance. In these cases, paying the cash rate of $110.00 directly can result in immediate savings compared to the higher negotiated amounts that insurance carriers may allow, as the administrative costs and contract structures often inflate the final billed amount for insured patients.
To maximize your savings, it is essential to verify if the facility offers additional "self-pay" or "prompt-pay" discounts before scheduling your visit, as these upfront payment incentives can further reduce the final cost. If you do receive a bill from an out-of-network provider or encounter unexpected charges, you should request a full itemized audit to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain inaccuracies. Furthermore, remember that the No Surprises Act protects you from balance billing for emergency care and non-emergency services at in-network facilities, so you should never feel pressured to sign away your rights to dispute out-of-network charges without first reviewing the specific terms of your coverage.