CMS Price Transparency Data

Blood antibody screen

Facility: Sanford Sheldon Medical Center

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $70
Cash Discount Price: $86
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Sanford Sheldon Medical Center is $70. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 1.31x the Medicare baseline. Located in 118 North Seventh Avenue, Po Box 250, Sheldon, IA.

Cash / Self-Pay

$86

Average discount available for prompt cash payment at this facility.

Insurance Median

$70

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: $86 (162%)

Insurance Median: $70 (131%)

Cash: $86 (162% of Medicare)

Ins. Median: $70 (131% 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
Sanford Health Plan Align	$31	58%
Aetna	$33 - $94	62%
Blue Cross Blue Shield	$33	62%
Health Partners	$33 - $81	62%
Medicare (plans)	$33	62%
Ucare	$33 - $95	62%
UnitedHealthcare	$33 - $90	62%
Primewest	$34	64%
Wellmark	$54 - $56	101%
Sanford Health Plan	$58 - $68	109%
Security Health Plan	$59	111%
Medica	$89 - $95	167%
First Choice Health Network	$97	182%
Healthez	$97	182%
Multiplan	$97	182%

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 $86.
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 Sanford Sheldon Medical Center 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.