CMS Price Transparency Data

Blood antibody screen

Facility: West Valley Medical Center

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $156
Cash Discount Price: $245
vs. Medicare Baseline: 2.93x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at West Valley Medical Center is $156. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $245. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 2.93x the Medicare baseline. Located in 1717 Arlington Street, Caldwell, ID.

Cash / Self-Pay

$245

Average discount available for prompt cash payment at this facility.

Insurance Median

$156

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: $245 (460%)

Insurance Median: $156 (293%)

Cash: $245 (460% of Medicare)

Ins. Median: $156 (293% 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 293% of the Medicare baseline (a markup of 193%). 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
Blue Cross Blue Shield	$8 - $1,026	15%
Molina	$8 - $10	15%
Humana	$10 - $220	19%
Regence Blue Shield	$10	19%
St Luke'S Health Partners	$10	19%
United	$10 - $156	19%
Veteran'S Administration	$10	19%
Select Health Idaho (Eirmc Only)	$73 - $83	137%
Corizon Health	$84 - $97	158%
True Blue	$90 - $103	169%
Cigna	$128 - $146	240%
Pacificsource Health	$136 - $156	255%
Regence	$140	263%
Moda	$142 - $163	267%
Aetna	$180 - $207	338%
Four Rivers Hospice	$182 - $209	342%
Multiplan	$182 - $209	342%
Geha Ppo Usa	$194 - $222	364%
Coventry First Health	$205 - $235	385%
St Alphonsus Health	$205 - $235	385%

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 $245.
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 West Valley 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.