CMS Price Transparency Data

Blood test, sodium

Facility: Pinckneyville Community Hospital

Billing Code: 84295 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84295
Insurance Median: $55
Cash Discount Price: $99
vs. Medicare Baseline: 11.43x Medicare

The contracted insurance negotiated median rate for a Blood test, sodium at Pinckneyville Community Hospital is $55. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $99. Compared to the federal Medicare reimbursement reference rate of $4.81, this hospital’s rate is 11.43x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$99

Average discount available for prompt cash payment at this facility.

Insurance Median

$55

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$4.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $4.81 (100%)

Cash / Self-Pay: $99 (2058%)

Insurance Median: $55 (1143%)

Cash: $99 (2058% of Medicare)

Ins. Median: $55 (1143% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $4.81 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 1143% of the Medicare baseline (a markup of 1043%). 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
Aetna	$24 - $89	499%
Ambetter / Centene	$24	499%
Blue Cross Blue Shield	$24 - $71	499%
Medicaid / KanCare	$24	499%
Humana	$37	769%
Umwa Mcr Adv - All Plans	$37	769%
UnitedHealthcare	$37 - $81	769%
Wellcare Mcr Adv - All Plans	$37	769%
Healthlink Hmo	$78	1622%
Phcs - All Other Plans	$81	1684%
Cigna	$82	1705%
Healthlink Ppo - All Other Plans	$82	1705%
Healthlink Work Comp	$82	1705%
Phcs Savility	$84	1746%
Multiplan - All Plans	$89	1850%

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 $99.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 84295.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Pinckneyville Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 84295.
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.