Blood antibody screen
Facility: Mitchell County Hospital Health Systems
Billing Code: 86850 (CPT)
- CPT Billing Code: 86850
- Insurance Median: $120
- Cash Discount Price: $113
- vs. Medicare Baseline: 2.25x 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 225% of the Medicare baseline (a markup of 125%). 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 |
|---|---|---|
| UnitedHealthcare | $53 - $126 | 100% |
| Blue Cross Blue Shield | $91 | 171% |
| Triwest Well Mark All Plans | $107 | 201% |
| Pref Hlth Care Sytms Comm - All Plans | $113 | 212% |
| First Health-All Plans | $113 | 212% |
| Aetna | $113 | 212% |
| Multiplan Ppo - All Plans | $120 | 225% |
| Auxiant-All Plans | $120 | 225% |
| Phc Leased Ntwrk Access - All Plans | $120 | 225% |
| Cigna | $125 | 235% |
| Health Partners Ks-All Plans | $125 | 235% |
Consumer Guidance & Cost Commentary
For the CPT code 86850, representing a blood antibody screen, the gross charge at Mitchell County Hospital Health Systems in Beloit, KS, is $126.00. This facility, a Critical Access Hospital owned by the local government, has negotiated rates ranging from $53.00 to $125.00 across 11 different payers, with a median negotiated rate of $120.00. While the cash median price is $113.00, which is lower than the negotiated rates, patients with high-deductible plans may find paying the cash price directly more cost-effective if their insurance allowed amount exceeds this figure. It is important to note that while the facility is in-network for these carriers, patients should verify their specific plan details and ask about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not billed the full negotiated amount.
When evaluating the cost of this service, it is essential to compare rates against the Medicare benchmark rather than the hospital's gross charges. The Medicare amount for this procedure is $53.24, which serves as a scientifically validated baseline for the true cost of delivery. The facility's cash median of $113.00 represents approximately 211% of the Medicare rate, while the median negotiated rate of $120.00 is roughly 225% of the Medicare benchmark. Given that fair pricing is typically defined as 120% to 150% of Medicare, the current rates reflect a significant markup common in commercial billing. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services