CMS Price Transparency Data

Blood antibody screen

Facility: Guadalupe Regional Medical Center

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $178
Cash Discount Price: $128
vs. Medicare Baseline: 3.34x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Guadalupe Regional Medical Center is $178. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $128. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 3.34x the Medicare baseline. Located in 1215 E Court St, Seguin, TX.

Cash / Self-Pay

$128

Average discount available for prompt cash payment at this facility.

Insurance Median

$178

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: $128 (240%)

Insurance Median: $178 (334%)

Cash: $128 (240% of Medicare)

Ins. Median: $178 (334% 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 334% of the Medicare baseline (a markup of 234%). 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
Aetna	$52 - $350	98%
Christus Exchange Health Plan	$52	98%
Mcr Clover Health	$52	98%
Mcr Texas Independence Health	$52	98%
Mcr Wellcare	$52	98%
Oscar Health Plan	$52	98%
Va Triwest Health Alliance	$52	98%
Superior Hlth Plan Mmcd	$53 - $185	100%
Healthcare Highways	$88 - $309	165%
UnitedHealthcare	$88 - $309	165%
Humana	$99 - $350	186%
Cigna	$105 - $371	197%
Texas Mutual Insurance Co	$105 - $371	197%
Blue Cross Blue Shield	$241 - $268	453%

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 $128.
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 Guadalupe Regional 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.