CMS Price Transparency Data

Blood antibody screen

Facility: St Nicholas Hospital

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86850
  • Insurance Median: $52
  • Cash Discount Price: $75
  • vs. Medicare Baseline: 0.98x Medicare
The contracted insurance negotiated median rate for a Blood antibody screen at St Nicholas Hospital is $52. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $75. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 0.98x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$75

Average discount available for prompt cash payment at this facility.

Insurance Median
$52

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: $75 (141%)
Insurance Median: $52 (98%)
Cash: $75 (141% of Medicare)
Ins. Median: $52 (98% 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
Blue Cross Blue Shield $5 - $52 9%
Community Care Family Care $5 9%
Managed Health Services $5 9%
Medicaid / KanCare $5 9%
Meridian Health Plan $5 9%
Molina Healthcare $6 - $52 11%
Triology $6 - $90 11%
P360 Small Group $12 23%
Prevea Health Network $12 23%
UnitedHealthcare $12 - $52 23%
Humana $17 - $97 32%
Aetna $52 - $114 98%
Medica $52 98%
Medicare (plans) $52 98%
Security Health Plan $52 - $73 98%
Molina Healthcare Of Wi $57 107%
Hshs Employees $62 116%
Arise Health Plan $68 128%
Wea Provider Network $71 - $82 133%
Cigna $80 150%
Interplan $80 150%
Network Health Plan $80 150%
Health Care Alliance $83 156%
Health Eos $86 162%
Healthsmart $86 162%
Wisconsin Physician Service $91 171%
Multiplan/Phcs $96 180%
Choicecare $97 182%
North Central Healthcare Alliance $105 197%
First Health $108 203%
Caterpillar, Inc. $114 214%
Cofinity $114 214%
Live360 $114 214%
Naphcare $116 218%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3100 Superior Ave, Sheboygan, WI 53081
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals