CMS Price Transparency Data

Blood antibody screen

Facility: Progress West Hospital

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $52
Cash Discount Price: $46
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Progress West Hospital is $52. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $46. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 0.98x the Medicare baseline. Located in 2 Progress Point Pkwy, Ofallon, MO.

Cash / Self-Pay

$46

Average discount available for prompt cash payment at this facility.

Insurance Median

$52

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: $46 (86%)

Insurance Median: $52 (98%)

Cash: $46 (86% of Medicare)

Ins. Median: $52 (98% 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
Humana	$11 - $52	21%
Healthscope Benefits [258]	$12	23%
UnitedHealthcare	$12 - $57	23%
Cigna	$13 - $21	24%
Consociate [478]	$14	26%
Sarah Bush Lincoln [636]	$14	26%
Aetna	$17 - $58	32%
Allied Benefits [498]	$17 - $57	32%
Coresource [497]	$17	32%
Fmh Benefit Service Inc [222]	$17	32%
Mail Handlers [495]	$17	32%
Apwu Health Plan [216]	$21	39%
Nalc Health Benefit Plan [242]	$21	39%
Priority Health [648]	$21	39%
Blue Cross Blue Shield	$23 - $67	43%
Healthlink [225]	$37 - $58	69%
Cox Health Systems Insurance Company [220]	$42 - $50	79%
Health Alliance [224]	$42	79%
Hope Trust [806]	$45	85%
Med-Pay [480]	$50 - $58	94%
Unicare [568]	$50 - $58	94%
Essence Healthcare [221]	$52	98%
Cox Health [757]	$55	103%
Devoted Health Plan [847]	$55	103%
Medica [662]	$55	103%
First Health Commercial [734]	$57	107%
Beechstreet [551]	$58	109%
Detego Health [868]	$58	109%
Health Systems Inc [620]	$58	109%
Healthcare Sol Mercy [609]	$58	109%
Multiplan Commercial [737]	$58	109%
Multiplan [240]	$58	109%
Phcs [244]	$58 - $62	109%
Preferred Health Professionals [561]	$58	109%
Hfn [563]	$62	116%
Medica [661]	$62	116%
Mh Magellan Health Services [270]	$77	145%

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 $46.
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 Progress West 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.