Blood test, potassium
Facility: Hamilton County Hospital
Billing Code: 84132 (CPT)
- CPT Billing Code: 84132
- Insurance Median: $38
- Cash Discount Price: $42
- vs. Medicare Baseline: 7.98x 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 $4.76 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 798% of the Medicare baseline (a markup of 698%). 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 | $5 - $10 | 105% |
| First Health Coventry - All Plans | $36 | 756% |
| Cigna | $40 | 840% |
| UnitedHealthcare | $40 | 840% |
| Va Ccn - All Plans | $42 | 882% |
| Aetna | $71 | 1492% |
Consumer Guidance & Cost Commentary
For this blood test for potassium at Hamilton County Hospital in Syracuse, KS, the cash price is $42.00, which matches the facility's negotiated rate for First Health Coventry, Cigna, and UnitedHealthcare. However, the median negotiated rate across all six payers is slightly lower at $38.00, while the highest negotiated rate is $71.00 with Aetna. It is important to note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures, meaning patients with high-deductible plans might save money by paying cash directly rather than relying on insurance, provided they have not yet met their deductible. Since the facility is a Critical Access Hospital with government-local ownership, patients should proactively ask about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the higher administrative costs associated with insurance billing cycles.
When evaluating the cost of this service, it is crucial to compare rates against the Medicare benchmark rather than the hospital's gross charge, as the latter is often inflated to make discounts appear larger. The Medicare amount for this code is $4.76, which serves as the objective baseline for fair pricing; commercial rates typically range from 200% to 300% of this figure, whereas fair pricing is generally defined as 120% to 150%. In this instance, the cash price of $42.00 represents approximately 883% of the Medicare rate, significantly higher than the typical commercial markup, suggesting that the facility's pricing structure may vary from standard industry norms. Additionally, the facility is located in zip code 67878,