CMS Price Transparency Data

Blood antibody screen

Facility: Adventist Health Clearlake

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $49
Cash Discount Price: $42
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Adventist Health Clearlake is $49. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 0.92x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$42

Average discount available for prompt cash payment at this facility.

Insurance Median

$49

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: $42 (79%)

Insurance Median: $49 (92%)

Cash: $42 (79% of Medicare)

Ins. Median: $49 (92% 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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	$2 - $126	4%
Blue Shield Mcr Adv	$2 - $69	4%
Kaiser Mcr Adv	$2 - $69	4%
Tricare	$2 - $69	4%
UnitedHealthcare	$3 - $274	6%
Ah Employee Health Plan - All Plans	$4 - $138	8%
Bc Managed Mcal	$4	8%
Medi-Cal	$4	8%
Partnership Mcal - All Plans	$4	8%
Aetna	$7 - $246	13%
Western Growers- All Plans	$7 - $247	13%
Blue Shield Epn - All Other Plans	$8 - $253	15%
Blue Shield Non-Epn	$8 - $253	15%
First Health- All Plans	$8 - $263	15%
Foundation- All Plans	$8 - $280	15%
Health Mgmt Network- All Plans	$8 - $280	15%
Healthnet- All Plans	$8 - $270	15%
Humana	$8 - $280	15%
Phcs- All Plans	$8 - $280	15%
Cigna	$9 - $296	17%
Interplan- All Plans	$9 - $296	17%
Kaiser- All Other Plans	$9 - $296	17%
Three Rivers Provider Network- All Plans	$9 - $296	17%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $42.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 86850.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health Clearlake is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 86850.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.