CMS Price Transparency Data

Blood antibody screen

Facility: Sanford Clear Lake Medical Center

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $120
Cash Discount Price: $116
vs. Medicare Baseline: 2.25x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Sanford Clear Lake Medical Center is $120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $116. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 2.25x the Medicare baseline. Located in 701 Third Avenue South, Clear Lake, SD.

Cash / Self-Pay

$116

Average discount available for prompt cash payment at this facility.

Insurance Median

$120

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: $116 (218%)

Insurance Median: $120 (225%)

Cash: $116 (218% of Medicare)

Ins. Median: $120 (225% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 225% of the Medicare baseline (a markup of 125%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$74	139%
Security Health Plan	$80	150%
Ucare	$80 - $127	150%
Wellmark Sd	$80	150%
Aetna	$81 - $126	152%
Health Partners	$81 - $109	152%
Medicare (plans)	$81	152%
UnitedHealthcare	$81 - $121	152%
Primewest	$82	154%
Sanford Health Plan	$101 - $135	190%
Blue Cross Blue Shield	$119 - $134	224%
Medica	$120 - $128	225%
Wellmark	$125 - $126	235%
Cigna	$130	244%
First Choice Health Network	$130	244%
Healthez	$130	244%
Multiplan	$130	244%

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 $116.
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 Clear Lake 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.