86850

Screening test for red blood cell antibodies

Medicare pricing data for 557 providers across 39 states

🤖AI Overview

This procedure has a 7.3x markup — hospitals charge $69.62 but Medicare allows only $9.55. Uninsured patients may face bills 7.3 times higher than what insurance negotiates. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Screening test for red blood cell antibodies (HCPCS code 86850) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $9.55, but hospitals typically charge $69.62 — a 7.3x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$1.91

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $9.55, your out-of-pocket cost would be approximately $1.91. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$9.55
Average Hospital Charge
$69.62
Markup Ratio
7.3x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$69.62
Medicare Allowed$9.55
Medicare Payment$9.55

Hospitals charge 7.3x more than what Medicare allows for this procedure. Medicare actually pays $9.55 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Rhode Island$11$30224+10.8%
Minnesota$10$791645,401+0.7%
Hawaii$10$303557+0.2%
Idaho$10$36213+0.2%
Indiana$10$421097+0.2%
Kansas$10$555505+0.2%
Kentucky$10$15421+0.2%
Louisiana$10$296102+0.2%
Maine$10$483457+0.2%
Massachusetts$10$5318185+0.2%
Nebraska$10$27339+0.2%
Nevada$10$516101+0.2%
New Mexico$10$891111+0.2%
North Dakota$10$865124+0.2%
South Dakota$10$59423+0.2%
Tennessee$10$49469+0.2%
Utah$10$28645+0.2%
Alabama$10$628399+0.2%
Arizona$10$665467+0.2%
Colorado$10$48686+0.2%
Connecticut$10$694331+0.2%
New Jersey$10$50112,916+0.1%
Oklahoma$10$515489+0.1%
Pennsylvania$10$5281,636+0.1%
Florida$10$89134,8590.0%
New York$10$138101,2860.0%
North Carolina$10$53101,0720.0%
California$10$47714,7750.0%
Texas$10$50211,196-0.1%
Virginia$10$14543,736-0.1%
Michigan$10$4310200-0.2%
Ohio$10$33151,727-0.2%
Maryland$10$3871,986-0.3%
Oregon$10$3210194-0.3%
Mississippi$10$365241-0.5%
Iowa$9$3725188-0.7%
Wisconsin$9$50271,956-0.8%
Washington$9$5310293-2.8%
Illinois$9$538385-3.1%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

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