CMS Price Transparency Data

Blood antibody screen

Facility: St Mary Medical Center

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $60
Cash Discount Price: $59
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at St Mary Medical Center is $60. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 1.13x the Medicare baseline. Located in Langhorne-Newtown Rd, Langhorne, PA.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$60

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: $59 (111%)

Insurance Median: $60 (113%)

Cash: $59 (111% of Medicare)

Ins. Median: $60 (113% 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
Pace-Trinity Health	$9	17%
Medicaid / KanCare	$10 - $20	19%
Aetna	$12 - $80	23%
UnitedHealthcare	$14 - $44	26%
Keystone First	$20	38%
Keystone First Chip	$20	38%
Amerihealth	$27	51%
Blue Cross Blue Shield	$27 - $68	51%
Blue Shield - Ca	$27	51%
Blue Shield - Id (Regence)	$27	51%
Blue Shield - Ny Highmark Western	$27	51%
Blue Shield - Wa (Regence)	$27	51%
Geha	$37	69%
Cigna	$53 - $62	100%
Align Senior Care	$57	107%
Medicare (plans)	$58 - $101	109%
Upmc Health Plan	$62	116%
Webtpa	$62	116%
Health America Advantra	$67	126%
Meritain	$80	150%
Multiplan	$81	152%
Prime Health Services	$81	152%
Galaxy Health Network	$86	162%
Three Rivers Provider Network	$86	162%
Ambetter / Centene	$100	188%
Oscar	$101	190%
Prime Healthcare	$101	190%
Jefferson Health Plan Commercial	$102	192%
Homestead Health Plans Woods Center	$110	207%
Group Pension Administrators	$126	237%
Reedman Toll	$126	237%
Blue Shield - Pa (Highmark)	$152	285%

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 $59.
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 St Mary Medical Center 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.