CMS Price Transparency Data

Blood antibody screen

Facility: South Pointe Hospital

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $45
Cash Discount Price: $42
vs. Medicare Baseline: 0.85x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at South Pointe Hospital is $45. 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 0.85x the Medicare baseline. Located in 20000 Harvard Road, Warrensville Heights, OH.

Cash / Self-Pay

$42

Average discount available for prompt cash payment at this facility.

Insurance Median

$45

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: $45 (85%)

Cash: $42 (79% of Medicare)

Ins. Median: $45 (85% 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	$15 - $47	28%
Oscar	$19 - $25	36%
Summacare	$22 - $50	41%
UnitedHealthcare	$25 - $50	47%
Cc Ehp	$26 - $168	49%
Paramount	$27	51%
Aetna	$28 - $64	53%
Aultcare	$28	53%
Blue Cross Blue Shield	$28 - $180	53%
Buckeye	$28	53%
Caresource	$28	53%
Molina	$28	53%
Amerihealth	$29	54%
Ohcp	$31	58%
Omas	$32	60%
Healthsmart	$35	66%
Ohio Healthy	$35	66%
Mmo	$36 - $89	68%
Php	$38	71%
The Health Plan	$38 - $50	71%
Upmc	$38 - $50	71%
Gms	$45	85%
Medical Benefit Corp	$45	85%
Quality Care Partners	$45	85%
Consociate Health	$48	90%
Devoted Health	$50	94%
Humana	$50 - $54	94%
Valor	$50	94%
Cigna	$51 - $64	96%
Communicare	$52	98%
Perennial Health	$53	100%
Pphp	$54	101%
Frontpath	$58	109%
Managed Care Services	$58	109%
Multiplan	$58	109%
Tertiary Care Network	$58	109%
Three Rivers	$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 South Pointe 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.