Blood antibody screen
Facility: Oakleaf Surgical Hospital
Billing Code: 86850 (CPT)
- CPT Billing Code: 86850
- Insurance Median: $52
- Cash Discount Price: $89
- vs. Medicare Baseline: 0.98x 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 | $52 | 98% |
| Dean Health Plan | $52 | 98% |
| Group Health Cooperative Of Eau Claire | $52 | 98% |
| Healthpartners | $52 | 98% |
| Humana | $52 | 98% |
| Medica | $52 | 98% |
| Quartz Health Solutions | $52 | 98% |
| Security Health Plan Of Wi | $52 - $876 | 98% |
| Ucare Wi | $52 | 98% |
| UnitedHealthcare | $52 | 98% |
Consumer Guidance & Cost Commentary
For this blood antibody screen performed at Oakleaf Surgical Hospital in Altoona, Wisconsin, the most significant financial insight is that the facility's cash median price of $89 is substantially lower than the state average of $99. While the gross charge listed is $99, patients utilizing insurance will face a negotiated rate of $52, which is significantly below the state average of $99 but still higher than the cash price. This pricing structure highlights a scenario where paying out-of-pocket at the cash rate of $89 may be more cost-effective than relying on insurance, particularly for patients with high-deductible plans where the insurance negotiated rate of $52 could still result in substantial out-of-pocket costs before coverage kicks in.
The facility, owned by physicians, reports a Medicare amount of $53.24, which serves as a key benchmark for evaluating the commercial pricing. Although the facility offers a median negotiated rate of $52 to ten different payers such as Blue Cross Blue Shield and UnitedHealthcare, the cash option remains the lowest fixed price available at $89. Consumers should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it is still prudent to request a prompt-pay discount before scheduling, as hospitals often offer fee reductions for upfront payment to bypass administrative claim processing costs. Patients are encouraged to verify their specific plan details and confirm any self-pay or prompt-pay discounts directly with the hospital prior to receiving services to ensure they are not surprised by the final amount due.