Blood antibody screen
Facility: William Newton Hospital
Billing Code: 86850 (CPT)
- CPT Billing Code: 86850
- Insurance Median: $23
- Cash Discount Price: $65
- vs. Medicare Baseline: 0.43x 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 |
|---|---|---|
| Blue Cross Blue Shield | $3 - $87 | 6% |
| UnitedHealthcare | $3 - $60 | 6% |
| Triwest- All Plans | $3 - $23 | 6% |
| Ambetter / Centene | $3 - $66 | 6% |
| Providrs Care Nexus | $5 - $41 | 9% |
| Providrs Care - All Other Plans | $6 - $46 | 11% |
Consumer Guidance & Cost Commentary
For the CPT code 86850, "Blood antibody screen," William Newton Hospital in Winfield, KS, lists a cash median price of $65.00, which matches the facility's gross charge. This cash rate is significantly lower than the state average for this service, as the median negotiated rate across six payers is $23.00. While commercial insurance contracts often result in lower allowed amounts than cash prices, patients with high-deductible plans may find paying the full cash price upfront more cost-effective if their insurance deductible has not yet been met. It is important to note that while the facility is a Critical Access Hospital with a government-local ownership structure, patients should verify their specific plan details before scheduling to ensure they understand their out-of-pocket responsibilities.
Patients should be aware that commercial insurance rates can sometimes exceed cash prices due to administrative costs and contract dynamics, making the cash option a potential savings strategy for those without active coverage. Additionally, if a patient receives care from an out-of-network provider or encounters unexpected ancillary services, they may face balance billing for the difference between the provider's full charge and the insurance allowed amount. To avoid surprise costs, consumers should request a full itemized bill before paying and dispute any errors or unbundled codes, as over 80% of hospital bills contain inaccuracies. Finally, patients are encouraged to ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the total amount owed by 20% to 50% when paid in full upfront.