CMS Price Transparency Data

Blood test, sodium

Facility: Hamilton Memorial Hospital

Billing Code: 84295 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84295
Insurance Median: $35
Cash Discount Price: $37
vs. Medicare Baseline: 7.28x Medicare

The contracted insurance negotiated median rate for a Blood test, sodium at Hamilton Memorial Hospital is $35. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $37. Compared to the federal Medicare reimbursement reference rate of $4.81, this hospital’s rate is 7.28x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$37

Average discount available for prompt cash payment at this facility.

Insurance Median

$35

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: $37 (769%)

Insurance Median: $35 (728%)

Cash: $37 (769% of Medicare)

Ins. Median: $35 (728% 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 728% of the Medicare baseline (a markup of 628%). 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
Medicaid / KanCare	$16 - $18	333%
Blue Cross Blue Shield	$17 - $40	353%
Aetna	$18 - $40	374%
Health Alliance	$18 - $35	374%
Humana	$18	374%
Medicare (plans)	$18	374%
UnitedHealthcare	$18 - $32	374%
Wellcare	$18	374%
Alliance Coal	$31	644%
Healthscope	$31	644%
Wellfirst (Ssmhic)	$31	644%
Hope Trust	$33	686%
Cigna	$35	728%
Hfn, Inc	$35 - $40	728%
Healthlink	$37 - $40	769%
Multiplan	$37	769%
Siho	$40	832%
Three Rivers Provider	$40	832%
Healthsmart	$42	873%
Stratose	$42	873%

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 $37.
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 Hamilton Memorial 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.