Blood antibody screen
Facility: Orthopaedic Hospital of Wisconsin
Billing Code: 86850 (CPT)
- CPT Billing Code: 86850
- Insurance Median: $9
- Cash Discount Price: $73
- vs. Medicare Baseline: 0.17x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 - $9 | 9% |
| Network Health Plan | $5 | 9% |
| Humana | $9 - $10 | 17% |
| Children'S Community Health Plan | $19 | 36% |
| The Alliance | $19 | 36% |
Consumer Guidance & Cost Commentary
For patients paying out of pocket, the most important thing to know is that the cash median rate for this Blood antibody screen is $73.00, which is significantly lower than the facility's gross charge of $139.00. If you have a high-deductible plan where your insurance deductible has not yet been met, paying this cash price upfront could be more cost-effective than using insurance, as the insurance negotiated rate averages $9.00 per plan but may still result in higher out-of-pocket costs if your deductible is high. To ensure you receive the best possible rate, it is highly recommended to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts before scheduling your visit, as these upfront fee reductions can further lower your total cost.
When viewed in the broader context of billing, the commercial insurance negotiated rate of $9.00 is notably lower than the cash price of $73.00, a common dynamic where administrative overhead and contract structures inflate insurance rates above cash prices. While the facility is an Acute Care Hospital in Glendale, Wisconsin, with a gross charge of $139.00, the actual amount paid varies by payer; for instance, Blue Cross Blue Shield pays $5.00 to $9.00 depending on the specific plan, and Humana pays between $9.00 and $10.00. Unlike the cash option, using insurance subjects you to potential balance billing if ancillary services are out-of-network, though the No Surprises Act offers protections for emergency care. Ultimately, the data shows that for this specific procedure, the commercial negotiated rate is $9.00, which is