CMS Price Transparency Data

Blood antibody screen

Facility: Prosser Memorial Hospital

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $161
Cash Discount Price: $111
vs. Medicare Baseline: 3.02x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Prosser Memorial Hospital is $161. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 3.02x the Medicare baseline. Located in 723 Memorial Street, Prosser, WA.

Cash / Self-Pay

$111

Average discount available for prompt cash payment at this facility.

Insurance Median

$161

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: $111 (208%)

Insurance Median: $161 (302%)

Cash: $111 (208% of Medicare)

Ins. Median: $161 (302% 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 302% of the Medicare baseline (a markup of 202%). 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
UnitedHealthcare	$18 - $81	34%
Community Health Plan Of Washington	$43 - $81	81%
Coordinated Care	$43 - $81	81%
Kaiser Permanente	$43 - $243	81%
Amerigroup	$45 - $86	85%
Molina	$45 - $81	85%
Health Alliance Northwest	$50	94%
Wellcare	$50	94%
Humana	$51 - $171	96%
Aetna	$60 - $171	113%
Ambetter / Centene	$141 - $155	265%
Asuris	$161 - $181	302%
Health Management Adminstrators	$161 - $181	302%
Premera	$161	302%
Regence	$161 - $181	302%
Cigna	$165	310%
First Choice	$171	321%
Multiplan	$171 - $181	321%

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 $111.
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 Prosser Memorial Hospital 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.