CMS Price Transparency Data

Ultrasound, pelvis

Facility: West Valley Medical Center

Billing Code: 76856 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 76856
Insurance Median: $726
Cash Discount Price: $1,215
vs. Medicare Baseline: 6.80x Medicare

The contracted insurance negotiated median rate for a Ultrasound, pelvis at West Valley Medical Center is $726. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,215. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 6.80x the Medicare baseline. Located in 1717 Arlington Street, Caldwell, ID.

Cash / Self-Pay

$1,215

Average discount available for prompt cash payment at this facility.

Insurance Median

$726

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $1,215 (1138%)

Insurance Median: $726 (680%)

Cash: $1,215 (1138% of Medicare)

Ins. Median: $726 (680% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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 680% of the Medicare baseline (a markup of 580%). 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	$26 - $1,155	24%
Molina	$26 - $55	24%
Regence	$219	205%
United	$245 - $726	229%
Select Health Idaho (Eirmc Only)	$388	363%
Corizon Health	$450	421%
True Blue	$480	449%
Cigna	$681	638%
Pacificsource Health	$726	680%
Moda	$757	709%
St Luke'S Health Partners	$790	740%
Aetna	$961	900%
Four Rivers Hospice	$972	910%
Multiplan	$972	910%
Humana	$1,021	956%
Geha Ppo Usa	$1,033	967%
Coventry First Health	$1,094	1024%
St Alphonsus Health	$1,094	1024%

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 $1,215.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 76856.

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 76856.
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.