Blood test, sodium
Facility: Nmc Health
Billing Code: 84295 (CPT)
- CPT Billing Code: 84295
- Insurance Median: $38
- Cash Discount Price: $41
- vs. Medicare Baseline: 7.90x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 790% of the Medicare baseline (a markup of 690%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | $10 | 208% |
| Aetna | $15 - $48 | 312% |
| Wppa | $32 | 665% |
| Occunet | $35 | 728% |
| Medincrease Health Plan | $38 | 790% |
| Samaritan Ministries International | $38 | 790% |
| Prime Health Services | $44 | 915% |
| UnitedHealthcare | $52 | 1081% |
| Cigna | $55 | 1143% |
Consumer Guidance & Cost Commentary
For this sodium blood test at Nmc Health in Newton, Kansas, the facility's negotiated rates range from $10 to $55 depending on your specific insurance plan, with a median negotiated amount of $38.00. While these rates are contractually agreed upon with carriers to protect in-network members, they often exceed the actual cost of the service. For comparison, the facility's cash price is $41.00, which is notably higher than the median negotiated rate of $38.00. This suggests that for patients with high-deductible plans who have not yet met their coverage threshold, paying the cash price directly might be more cost-effective than using insurance, as the insurer would likely pay the higher negotiated rate of $38.00 or more. Additionally, the facility's cash price is significantly higher than the Medicare benchmark of $4.81, indicating a substantial markup above the federal government's calculated cost baseline.
To minimize costs, it is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront. Since hospitals often charge 5x more for the same service depending on their network tier, verifying the exact allowed amount for your specific plan before scheduling is crucial. Furthermore, if you receive a bill after using insurance, request a full itemized CPT-coded statement rather than accepting a summary bill, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. Given that the facility is a voluntary non-profit acute care hospital, you may also have additional leverage to negotiate a fair price based on