Blood antibody screen
Facility: Trego County Lemke Memorial Hospital
Billing Code: 86850 (CPT)
- CPT Billing Code: 86850
- Insurance Median: $55
- Cash Discount Price: $55
- vs. Medicare Baseline: 1.03x 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.
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 | $32 | 60% |
| Tricare | $34 | 64% |
| UnitedHealthcare | $40 - $65 | 75% |
| Medicaid / KanCare | $40 - $65 | 75% |
| Aetna | $40 - $58 | 75% |
| Ambetter / Centene | $44 | 83% |
| Health Partners - All Plans | $62 | 116% |
| Healthy Blue Mcaid - All Plans | $65 | 122% |
| Blue Cross Blue Shield | $125 | 235% |
Consumer Guidance & Cost Commentary
For the CPT code 86850, representing a blood antibody screen, the facility's cash median rate is $55.00, which is lower than the state average of $65.00. While commercial payers negotiate rates ranging from $32 to $125 depending on the plan, patients with high-deductible plans may find paying out-of-pocket cheaper if the insurance negotiated rate exceeds the cash price. It is important to note that the facility, Trego County Lemke Memorial Hospital, is a Critical Access Hospital in Wakeeney, KS, and offers a prompt-pay discount for upfront billing, which can further reduce the final amount owed.
The Medicare benchmark for this service is $53.24, serving as a reliable baseline to evaluate pricing fairness. Although the facility's cash rate of $55.00 is slightly above the Medicare amount, it remains below the gross charges and aligns closely with the median negotiated rate of $55.00 seen across Medicaid and Ambetter plans. Patients should request an itemized billing audit before payment to ensure no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors. Additionally, since the facility is owned by the local government, patients should verify if specific self-pay or prompt-pay discounts are available prior to scheduling to avoid unexpected balance billing.