CMS Price Transparency Data

Blood antibody screen

Facility: Prisma Health Tuomey Hospital

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86850
  • Insurance Median: $51
  • Cash Discount Price: $96
  • vs. Medicare Baseline: 0.96x Medicare
The contracted insurance negotiated median rate for a Blood antibody screen at Prisma Health Tuomey Hospital is $51. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $96. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 0.96x the Medicare baseline. Located in 129 N Washington St, Sumter, SC.
Cash / Self-Pay
$96

Average discount available for prompt cash payment at this facility.

Insurance Median
$51

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: $96 (180%)
Insurance Median: $51 (96%)
Cash: $96 (180% of Medicare)
Ins. Median: $51 (96% 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.

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
Golden Rule Insurance Company [2991] $9 17%
Oxford Health Plans [2992] $9 17%
UnitedHealthcare $9 - $50 17%
Zzumr-Salt Lake City Ut [3169] $9 17%
Medicaid / KanCare $15 - $37 28%
Blue Cross Blue Shield $19 - $82 36%
Bluechoice [810] $19 - $82 36%
Scdc-Sc Dept Of Corrections [7232] $21 39%
Prisma Health Seniorcare Pace - Midlands [5400] $34 64%
Prisma Health Seniorcare Pace-Upstate [5200] $34 64%
Humana $47 - $111 88%
Cigna $49 - $56 92%
Covid19 Hrsa Uninsured Testing & Treatment Fund [904] $49 92%
Medicare (plans) $49 - $51 92%
Triwest Healthcare Alliance Vcp [902] $49 92%
Va Community Care Network-Vaccn [903] $49 92%
Tricare $50 94%
Aetna $51 - $117 96%
Healthy Conn Prime-First Choice Vip Care [5300] $51 96%
Healthy Conn Prime-Molina Healthcare [5330] $51 96%
Healthy Conn Prime-Wellcare Prime By Atc [5310] $51 96%
Promise Health Plan Contracted [2401] $52 - $89 98%
Orangeburg Senior Helping Center Pace [5401] $59 111%
Workers Comp [600] $68 128%
Planned Administrators [820] $82 154%
Bob Jones Univ-Pai [821] $89 167%
Ambetter / Centene $90 169%
Meritain Health Contracted [2200] $95 - $117 178%
Preferred Administrators Contracted [2839] $104 195%
Medcost [2940] $110 - $123 207%
Atlantic Packaging Contracted [4833] $111 208%
Aps Healthcare System [2981] $118 222%
Multiplan/Phcs Contracted [2950] $132 248%
Vsp Vision Care [2986] $133 250%
First Health Contracted [2952] $138 259%
Furman Int/Allen University Student [2951] $138 259%
Quiktrip-First Health [3067] $138 259%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 129 N Washington St, Sumter, SC 29150
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals