CMS Price Transparency Data

Blood test, sodium

Facility: Valley West Community Hospital

Billing Code: 84295 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84295
Insurance Median: $48
Cash Discount Price: $53
vs. Medicare Baseline: 9.98x Medicare

The contracted insurance negotiated median rate for a Blood test, sodium at Valley West Community Hospital is $48. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $53. Compared to the federal Medicare reimbursement reference rate of $4.81, this hospital’s rate is 9.98x the Medicare baseline. Located in 11 East Pleasant Avenue, Sandwich, IL.

Cash / Self-Pay

$53

Average discount available for prompt cash payment at this facility.

Insurance Median

$48

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: $53 (1102%)

Insurance Median: $48 (998%)

Cash: $53 (1102% of Medicare)

Ins. Median: $48 (998% 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 998% of the Medicare baseline (a markup of 898%). 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	$13 - $65	270%
Global Excel [1712]	$13 - $15	270%
Humana	$13 - $15	270%
Aetna	$18 - $55	374%
Health'S Finest Network [126]	$32 - $68	665%
The Alliance [1703]	$38 - $43	790%
Choicecare [177]	$47 - $54	977%
Healthlink [125]	$52 - $60	1081%
Multiplan/Phcs [142]	$56 - $80	1164%
First Health Plan [6034]	$70 - $80	1455%
UnitedHealthcare	$70 - $80	1455%

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 $53.
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 Valley West 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.