CMS Price Transparency Data

Blood antibody screen

Facility: Children's Hospital of Philadelphia

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $255
Cash Discount Price: $565
vs. Medicare Baseline: 4.79x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Children's Hospital of Philadelphia is $255. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $565. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 4.79x the Medicare baseline. Located in 3401 Civic Center Blvd, Philadelphia, PA.

Cash / Self-Pay

$565

Average discount available for prompt cash payment at this facility.

Insurance Median

$255

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: $565 (1061%)

Insurance Median: $255 (479%)

Cash: $565 (1061% of Medicare)

Ins. Median: $255 (479% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 479% of the Medicare baseline (a markup of 379%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Geisinger Medical Assistance	$11	21%
Highmark Wholecare	$13	24%
Horizon Nj Health	$15	28%
Medicaid / KanCare	$89 - $97	167%
UnitedHealthcare	$90 - $325	169%
Health Partners	$102 - $111	192%
Aetna	$128 - $295	240%
Upmc Medical Assistance	$147 - $161	276%
Keystone First Chip	$167 - $183	314%
Keystone Health Plan East	$171 - $187	321%
Blue Cross Blue Shield	$191 - $237	359%
Geisinger Health Plan Commercial	$238 - $260	447%
Jefferson Health Plans	$255 - $279	479%
Cigna	$270 - $295	507%
Highmark	$270 - $295	507%
Qualcare	$297 - $325	558%
First Health Network	$351 - $384	659%
Devon Health, Intergroup, Multiplan, Valley Preferred/Populytics	$432 - $473	811%
Private Health Care Systems	$432 - $473	811%
Choice Care Network	$486 - $532	913%

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 $565.
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 Children's Hospital of Philadelphia 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.