CMS Price Transparency Data

Blood antibody screen

Facility: Merit Health Madison

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $90
Cash Discount Price: $51
vs. Medicare Baseline: 1.69x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Merit Health Madison is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $51. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 1.69x the Medicare baseline. Located in 161 River Oaks Drive, Canton, MS.

Cash / Self-Pay

$51

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $51 (96%)

Insurance Median: $90 (169%)

Cash: $51 (96% of Medicare)

Ins. Median: $90 (169% 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
United	$9	17%
United_Exchange	$9	17%
Ms-Can-Magnolia	$42	79%
Ms-Can-Molina	$42	79%
Ms-Can-Truecare	$43	81%
Medicare (plans)	$47	88%
Wellcare	$48	90%
Devoted_Health	$49	92%
Humana	$49	92%
Molina-Chip	$90	169%
Magnolia-Chip	$92	173%
Mpcn	$92	173%
Truecare-Chip	$92	173%
Firstchoice	$94	177%
Molina_Exchange	$101	190%
Advhealth	$102	192%
Cigna	$114	214%
Ambetter / Centene	$122	229%
Blue Cross Blue Shield	$127	239%

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 $51.
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 Merit Health Madison 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.