CMS Price Transparency Data

Blood antibody screen

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $90
Cash Discount Price: $115
vs. Medicare Baseline: 1.69x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at UPMC Children's Hospital of Pittsburgh is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $115. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 1.69x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$115

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: $115 (216%)

Insurance Median: $90 (169%)

Cash: $115 (216% 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
Aetna	$9 - $105	17%
Blue Cross Blue Shield	$10 - $39	19%
Health Plan Of Upper Ohio Valley	$10 - $124	19%
Amerihealth Caritas	$11 - $32	21%
Cigna	$11 - $105	21%
Upmc Health Plan	$20 - $54	38%
Health Partners Plans (Jefferson Health Plan)	$33	62%
Highmark Wholecare (Prev Gateway)	$34	64%
Pa Health & Wellness	$34	64%
UnitedHealthcare	$34 - $90	64%
Geisinger	$35 - $86	66%
Intergroup	$124 - $162	233%
Coventry/First Health	$153	287%
Saudi Armed Forces	$153	287%
Health Payors Organization	$162	304%
Multiplan	$162	304%
National Provider Network	$172	323%
Private Health Care Systems	$172	323%

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 $115.
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 UPMC Children's Hospital of Pittsburgh 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.