Blood test, sodium
Facility: Rooks County Health Center
Billing Code: 84295 (CPT)
- CPT Billing Code: 84295
- Insurance Median: $54
- Cash Discount Price: $45
- vs. Medicare Baseline: 11.23x 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 1123% of the Medicare baseline (a markup of 1023%). 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 |
|---|---|---|
| Veterans Admin - All Plans | $3 | 62% |
| Blue Cross Blue Shield | $10 | 208% |
| Celtic Mcr Adv | $28 | 582% |
| Tricare | $28 | 582% |
| Celtic Comm - All Other Plans | $31 | 644% |
| UnitedHealthcare | $54 | 1123% |
| Aetna | $54 | 1123% |
| Preferred Benefits Admin | $54 | 1123% |
| Health Partners - All Plans | $57 | 1185% |
| Preferred Hlthcare - All Other Plans | $57 | 1185% |
| Healthy Blue Mcaid - All Plans | $60 | 1247% |
Consumer Guidance & Cost Commentary
For the blood test for sodium (CPT 84295) at Rooks County Health Center in Plainville, KS, the facility's cash price of $45.00 is lower than the state average of $54.00 and the county average of $45.00. While the facility's negotiated rate is $54.00, which matches the state average, patients with high-deductible plans may find paying the cash price directly more beneficial if their insurance negotiated rate exceeds this amount. It is important to note that the facility's cash rate is also lower than the Medicare benchmark of $4.81, which serves as the objective baseline for evaluating pricing markups; however, commercial negotiated rates often run significantly higher than this federal standard due to administrative costs and contract dynamics.
When using insurance, the allowed amount for this service is $54.00 across all listed payers, including Veterans Admin, Blue Cross Blue Shield, and UnitedHealthcare. This means that if a patient's deductible has not been met, they could be responsible for the full $54.00, which is higher than the cash price. To potentially reduce costs, patients should ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can lower the final bill. Additionally, since this is a Critical Access Hospital, patients should verify their specific plan details to ensure they are aware of any potential balance billing scenarios, though the No Surprises Act provides protections against unexpected out-of-network charges for emergency and non-emergency services at in-network facilities.