CMS Price Transparency Data

Blood antibody screen

Facility: Fairview Hospital

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $54
Cash Discount Price: $80
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Fairview Hospital is $54. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 1.01x the Medicare baseline. Located in 29 Lewis Avenue, Great Barrington, MA.

Cash / Self-Pay

$80

Average discount available for prompt cash payment at this facility.

Insurance Median

$54

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$53.24

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $53.24 (100%)

Cash / Self-Pay: $80 (150%)

Insurance Median: $54 (101%)

Cash: $80 (150% of Medicare)

Ins. Median: $54 (101% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Capital District Physicians' Health Plan	$6 - $76	11%
Medicaid / KanCare	$6 - $9	11%
Bmchnp	$9 - $10	17%
Health New England	$9 - $59	17%
Point32Health	$9 - $80	17%
Fallon	$10 - $37	19%
Hospice	$10 - $33	19%
Medicare (plans)	$10 - $32	19%
Other Government	$10 - $33	19%
Unicare	$10 - $55	19%
UnitedHealthcare	$10 - $73	19%
Blue Cross Blue Shield	$11 - $72	21%
Commcare Alliance	$11 - $32	21%
Aetna	$14 - $64	26%
Comm Fallon Qhp	$15 - $52	28%
Workers Comp	$54	101%
Allways Nhp	$55	103%
Comm Hne Hmo	$56 - $63	105%
Comm Hne Ppo	$59 - $63	111%
Cigna	$76 - $79	143%
Mvp	$76	143%
Oxford	$76	143%
First Health	$79 - $80	148%
Connecticare	$80	150%
Consolidated Health Plans	$80	150%
Other Commercial	$80	150%
Phcs	$80	150%
Self Pay	$80	150%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $80.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 86850.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Fairview Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 86850.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.