Blood antibody screen
Facility: Clay County Medical Center
Billing Code: 86850 (CPT)
- CPT Billing Code: 86850
- Insurance Median: $124
- Cash Discount Price: $133
- vs. Medicare Baseline: 2.33x 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 233% of the Medicare baseline (a markup of 133%). 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 | $68 - $178 | 128% |
| Aetna | $68 - $178 | 128% |
| UnitedHealthcare | $70 - $182 | 131% |
| Health Partners - All Plans | $70 - $182 | 131% |
| Multiplan- All Plans | $70 - $182 | 131% |
Consumer Guidance & Cost Commentary
For the CPT code 86850, "Blood antibody screen," Clay County Medical Center in Clay Center, KS, has a cash median price of $133.00, which matches the facility's gross charge. This rate is significantly higher than the state average, as indicated by a 2.3x multiplier compared to the Medicare benchmark of $53.24. While the facility is a Critical Access Hospital with government local ownership, patients with high-deductible plans might find the cash price more affordable than their insurance negotiated rate, which averages $124.00 across five payers including Wppa/Providrs Care, Aetna, and UnitedHealthcare. Because commercial negotiated rates often include administrative overhead and contract markups, paying cash upfront can sometimes result in lower out-of-pocket costs if the patient's deductible has not yet been met.
To minimize potential balance billing or unexpected charges, patients should verify whether the facility offers "self-pay" or "prompt-pay" discounts before scheduling, as these programs can provide immediate fee reductions by bypassing insurance billing cycles. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to request an itemized billing audit if a summary bill is received, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. By comparing the facility's rates directly to the Medicare benchmark rather than the inflated chargemaster list, consumers can better understand the true cost of care and negotiate effectively with the billing department.