CMS Price Transparency Data

Blood antibody screen

Facility: Wentworth-Douglass Hospital

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $93
Cash Discount Price: $79
vs. Medicare Baseline: 1.75x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Wentworth-Douglass Hospital is $93. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $79. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 1.75x the Medicare baseline. Located in 789 Central Ave, Dover, NH.

Cash / Self-Pay

$79

Average discount available for prompt cash payment at this facility.

Insurance Median

$93

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: $79 (148%)

Insurance Median: $93 (175%)

Cash: $79 (148% of Medicare)

Ins. Median: $93 (175% 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
Blue Cross Blue Shield	$55 - $357	103%
Tricare	$56	105%
Medicare (plans)	$56	105%
Harvard Pilgrim [120001]	$57 - $95	107%
Aetna	$57 - $91	107%
Mgb Health Plan [150001]	$70 - $101	131%
Coventry First Health [1021]	$91	171%
Harvard Pilgrim Alternate [120002]	$95	178%
UnitedHealthcare	$95 - $101	178%
PHCS Multiplan [1022]	$111	208%
Wellpoint [1015]	$288	541%

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 $79.
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 Wentworth-Douglass 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.