Blood antibody screen
Facility: Charleston Area Medical Center
Billing Code: 86850 (CPT)
- CPT Billing Code: 86850
- Insurance Median: $24
- Cash Discount Price: $146
- vs. Medicare Baseline: 0.45x 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 |
|---|---|---|
| The Health Plan of West Virginia Inc. | $9 - $142 | 17% |
| Aetna | $9 - $143 | 17% |
| Triwest VA | $9 | 17% |
| Unicare Health Plan of West Virginia Inc. | $9 | 17% |
| West Virginia Senior Advantage Inc. | $10 | 19% |
| Optimum Choice Inc. | $10 | 19% |
| Blue Cross Blue Shield | $10 - $133 | 19% |
| UnitedHealthcare | $10 - $143 | 19% |
| Choicecare Network | $10 - $143 | 19% |
| Integrated Medical Solutions | $19 | 36% |
| Naphcare | $20 | 38% |
| Caresource | $24 | 45% |
| Tricare | $88 | 165% |
| City of Charleston | $110 | 207% |
| Cigna | $136 | 255% |
| Three Rivers Providers Network | $142 | 267% |
| Healthsmart | $143 | 269% |
| Multiplan | $143 | 269% |
Consumer Guidance & Cost Commentary
For this blood antibody screen service at Charleston Area Medical Center, the cash price of $146 is significantly lower than the facility's gross charge of $146 and represents a substantial savings compared to the state average of $146. While the cash rate matches the listed gross amount, the median negotiated rate for commercial payers is $24, which is notably lower than the cash price. This pricing structure highlights a common scenario where in-network insurance coverage results in a lower allowed amount than the cash-pay option, meaning patients with high-deductible plans might find paying out-of-pocket $146 to be more financially advantageous than having their insurance apply a $24 negotiated rate if their deductible has not yet been met.
The facility, a voluntary non-profit acute care hospital in Charleston, WV, shows a wide range of negotiated rates depending on the specific insurance plan, with high values reaching up to $190 and low values as low as $9 across 18 different payers. For instance, while major networks like Blue Cross Blue Shield and UnitedHealthcare have high-end negotiated rates between $133 and $143, smaller plans such as Triwest VA and Unicare Health Plan show a flat rate of $9. Medicare reimbursement for this procedure is set at $53.24, which serves as a key benchmark; commercial negotiated rates vary considerably but often fall below the cash price, reinforcing the importance of verifying self-pay or prompt-pay discounts before scheduling to ensure the lowest possible out-of-pocket cost.