CMS Price Transparency Data

Blood antibody screen

Facility: Valley Children's Hospital

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 86850
  • Insurance Median: $161
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 3.02x Medicare
The contracted insurance negotiated median rate for a Blood antibody screen at Valley Children's Hospital is $161. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 3.02x the Medicare baseline. Located in 9300 Valley Childrens Place, Madera, CA.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$161

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%)
Insurance Median: $161 (302%)
Ins. Median: $161 (302% 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 302% of the Medicare baseline (a markup of 202%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Allcare Ipa $13 24%
Kaiser $13 - $209 24%
Central California Alliance For Health $18 34%
Dignity Ipa_Formerly Img $18 34%
La Salle Ipa $18 34%
Sante Ipa $18 34%
Central Valley Medical Providers Ipa $20 - $161 38%
Sequoia Health Ipa $20 38%
United Physicians Network Ipa $20 38%
Univseral Healthcare Ipa $20 38%
Community Care Ipa $21 39%
Adventist $23 43%
Blue Cross Blue Shield $24 - $97 45%
Cencal Health $26 49%
Kern Family Health Care $26 49%
Health Net $113 - $211 212%
UnitedHealthcare $122 229%
Dignity Health Central Coast $160 301%
Community Health $177 332%
Stanislaus Partners In Health $177 332%
Physicians Choice Medical Group $180 338%
Health Plan Of San Joaquin $193 363%
Fowler Packing $200 376%
Dignity (Formerly Managed Care Systems) $203 381%
Kern Legacy $209 393%
Blue Shield $215 - $244 404%
Aetna $216 406%
First Health Formerly Coventry $238 447%
Bakersfield Family Medical Group $242 455%
Network By Design $250 470%
Community Care Health Plan $258 485%
Health Smart $258 485%
Key Medical Ipa $258 485%
Sutter Health $274 515%
Multiplan $308 579%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 9300 Valley Childrens Place, Madera, CA 93636
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Childrens