Blood test, sodium
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 84295 (CPT)
- CPT Billing Code: 84295
- Insurance Median: $8
- Cash Discount Price: $59
- vs. Medicare Baseline: 1.66x 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.
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 |
|---|---|---|
| UnitedHealthcare | $4 - $83 | 83% |
| Aetna | $4 - $5 | 83% |
| United Medical Resources Contracted [320454] | $4 - $13 | 83% |
| Medicaid / KanCare | $4 - $7 | 83% |
| Humana | $4 - $5 | 83% |
| First Health Contracted [320128] | $4 | 83% |
| Blue Cross Blue Shield | $4 - $7 | 83% |
| Mercy Hospice Okc [20252] | $5 | 104% |
| Pace Of The Ozarks Contracted [320518] | $5 | 104% |
| Tricare | $5 | 104% |
| Medicare (plans) | $5 | 104% |
| Kindful Hospice [20434] | $5 | 104% |
| Medica Contracted [320239] | $5 | 104% |
| Mercy Mgd Behavioral Health Contracted [320259] | $5 | 104% |
| Provider Partners Health Plans Contracted [320450] | $5 | 104% |
| Globalhealth Contracted [320145] | $5 | 104% |
| Cherokee Nation Health Serv Contracted [320066] | $5 | 104% |
| Halo Hcr Inc Hospice [20432] | $5 | 104% |
| Kindful Hospice Contracted [320434] | $5 | 104% |
| Medical Associates Health Contracted [320444] | $5 | 104% |
| Elara Caring Aspire Hospice [20433] | $5 | 104% |
| Dept Of Veteran Affairs Contracted [320106] | $5 | 104% |
| Halo Hcr Inc Hospice Contracted [320432] | $5 | 104% |
| Cigna | $5 - $27 | 104% |
| Qual Choice Contracted [320325] | $5 | 104% |
| Cross Timbers Hospice [20098] | $5 | 104% |
| Centivo Contracted [320505] | $8 | 166% |
| Providrs Care Network Contracted [320484] | $9 | 187% |
| Point C Contracted [320238] | $13 - $68 | 270% |
| Insurance System Inc Contracted [320465] | $13 | 270% |
| Healthscope Contracted [320182] | $13 - $68 | 270% |
| Benefit Management Contracted [320052] | $13 | 270% |
| Health Systems Inc Contracted [320174] | $13 | 270% |
| Show-Me Health Administrators Contracted [320483] | $30 | 624% |
| Mercy Benefit Admin Contracted [320251] | $30 - $63 | 624% |
| Imagine 360 Contracted [320494] | $63 | 1310% |
| Aither Health Contracted [320449] | $63 | 1310% |
| Reflect Health Contracted [320492] | $63 | 1310% |
| Auxiant Contracted [320462] | $63 - $68 | 1310% |
| Yuzu Health Contracted [320521] | $63 | 1310% |
| American Healthcare Alliance Contracted [320020] | $63 | 1310% |
| Ebms Contracted [320493] | $63 | 1310% |
| Edison Health Solutions Contracted [320502] | $63 | 1310% |
| Healthlink Contracted [320179] | $68 | 1414% |
| Preferred Health Plan Contracted [320522] | $68 | 1414% |
| Federal Medical Center Contracted [320127] | $68 | 1414% |
| Compcare Of The Ozarks Contracted [320437] | $71 | 1476% |
| Workers Comp [20426] | $72 | 1497% |
| Private Health Care Systems Contracted [320320] | $83 | 1726% |
| Multiplan [20270] | $86 | 1788% |
| Multiplan Contracted [320270] | $86 | 1788% |
Consumer Guidance & Cost Commentary
For the CPT code 84295 (Blood test, sodium), the gross charge at Mercy Specialty Hospital Southeast Kansas is $90.00. This facility's cash median price of $59.00 is significantly lower than the negotiated rates paid by most insurance plans, which range from $4 to $83 depending on the payer. For example, UnitedHealthcare plans pay between $4 and $83, while Medicaid/KanCare plans pay between $4 and $7. Patients with high-deductible plans may find the cash price more advantageous, as paying upfront can bypass the administrative overhead and potential markups associated with insurance billing cycles. It is important to note that while the facility is a voluntary non-profit acute care hospital in Galena, KS, the negotiated rates vary widely across the 51 payers listed, with some commercial contracts reaching as high as $86.
When comparing costs to federal benchmarks, the Medicare amount for this service is $4.81. The facility's cash price of $59.00 represents a markup of approximately 1.7 times the Medicare rate, which aligns with typical commercial pricing structures where negotiated rates often exceed 200% of Medicare. However, the median negotiated rate across all payers is $8.00, which is notably lower than the gross charge and suggests that many insurance contracts are well below the facility's list price. Consumers should be aware that balance billing is generally prohibited for emergency services under the No Surprises Act, but it is crucial to request an itemized bill before payment to ensure no unbundled charges or services not rendered are included. Additionally, patients should inquire about prompt-pay discounts,