Blood antibody screen
Facility: Memorial Hospital
Billing Code: 86850 (CPT)
- CPT Billing Code: 86850
- Insurance Median: $117
- Cash Discount Price: $156
- vs. Medicare Baseline: 2.20x 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 220% of the Medicare baseline (a markup of 120%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $59 | 111% |
| Tricare | $65 - $108 | 122% |
| Humana | $65 - $108 | 122% |
| Medicare (plans) | $66 - $109 | 124% |
| Ambetter / Centene | $72 - $118 | 135% |
| Coventry - All Other Plans | $117 - $194 | 220% |
| Preferred Healthcare-All Plans | $124 - $204 | 233% |
| Health Partners Of Kansas - All Plans | $124 - $204 | 233% |
| Wppa/Providers Care-All Plans | $182 - $301 | 342% |
Consumer Guidance & Cost Commentary
For the CPT code 86850, representing a blood antibody screen at Memorial Hospital in Abilene, KS, the cash price is $156.00, which matches the facility's median negotiated rate of $117.00. This cash price is significantly lower than the facility's gross charge of $156.00, though it remains higher than the Medicare benchmark of $53.24. When compared to the broader market, the facility's cash rate is notably higher than the lowest negotiated rates found among payers like Blue Cross Blue Shield ($59) and Tricare ($65), but it falls within the range of other major insurers such as Humana ($65–$108) and Medicare plans ($65–$108). Patients with high-deductible plans may find the $156.00 cash price advantageous if their insurance negotiated rates exceed this amount, as paying out-of-pocket could result in immediate savings compared to the administrative costs and potential deductibles associated with using commercial insurance.
While the facility's cash rate is higher than the lowest payer rates, it is comparable to the median negotiated rate of $117.00 and the median paid amount of $117.00 across the nine payers listed. The facility, a Critical Access Hospital owned by a Government Hospital District, reports a facility rating of 2, which may influence its pricing strategy relative to state and county averages. To ensure you receive the most favorable rate, it is recommended to explicitly request a "self-pay" or "prompt-pay" discount before scheduling your visit, as these upfront payment incentives can reduce the final bill by