CMS Price Transparency Data

Blood antibody screen

Facility: Promedica Monroe Regional Hospital

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $31
Cash Discount Price: $42
vs. Medicare Baseline: 0.58x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Promedica Monroe Regional Hospital is $31. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 0.58x the Medicare baseline. Located in 718 N Macomb St, Monroe, MI.

Cash / Self-Pay

$42

Average discount available for prompt cash payment at this facility.

Insurance Median

$31

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: $42 (79%)

Insurance Median: $31 (58%)

Cash: $42 (79% of Medicare)

Ins. Median: $31 (58% 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
UnitedHealthcare	$6 - $53	11%
Aetna	$9 - $52	17%
Paramount Healthcare Inc	$9 - $50	17%
Blue Cross Blue Shield	$10 - $52	19%
Health Alliance Plan	$10 - $53	19%
Humana	$10 - $53	19%
Priority Health	$10 - $52	19%
Amerihealth	$19	36%
Meridian	$29	54%
Molina Healthcare Of Michigan	$31	58%
Frontpath	$38	71%
Cofinity	$46	86%
Encore Health Network	$46	86%
Health Ohio Network, Llc	$46	86%
Veterans Affairs	$53	100%
Multiplan	$58	109%

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 $42.
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 Promedica Monroe Regional 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.