CMS Price Transparency Data

Blood antibody screen

Facility: Mountain West Medical Center

Billing Code: 86850 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 86850
Insurance Median: $49
Cash Discount Price: $74
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Blood antibody screen at Mountain West Medical Center is $49. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $74. Compared to the federal Medicare reimbursement reference rate of $53.24, this hospital’s rate is 0.92x the Medicare baseline. Located in 2055 North Main Street, Tooele, UT.

Cash / Self-Pay

$74

Average discount available for prompt cash payment at this facility.

Insurance Median

$49

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: $74 (139%)

Insurance Median: $49 (92%)

Cash: $74 (139% of Medicare)

Ins. Median: $49 (92% 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
Pehp-All Plans	$6 - $18	11%
Blue Cross Blue Shield	$10	19%
Select Health McR Adv	$10	19%
Medicare (plans)	$12	23%
Wise/Motivhealth-All Plans	$39 - $122	73%
U of Ut-All Plans	$39 - $122	73%
Dmba-All Plans	$43 - $135	81%
Cigna	$43 - $133	81%
Aetna	$45 - $140	85%
Select Health-All Other Plans	$45 - $140	85%
UnitedHealthcare	$46 - $144	86%
Multiplan Primary Network-All Other Plans	$47 - $148	88%
Humana	$51 - $159	96%
Emi-All Plans	$51 - $159	96%
Multiplan Complimentary Network	$55 - $172	103%

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 $74.
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 Mountain West 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.