Blood test, sodium
Facility: Graham County Hospital
Billing Code: 84295 (CPT)
- CPT Billing Code: 84295
- Insurance Median: $15
- Cash Discount Price: $27
- vs. Medicare Baseline: 3.12x 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 312% of the Medicare baseline (a markup of 212%). 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 |
|---|---|---|
| UnitedHealthcare | $1 - $26 | 21% |
| Medicaid / KanCare | $7 | 146% |
| Blue Cross Blue Shield | $10 | 208% |
| Medicare (plans) | $20 | 416% |
| Celtic Commercial-All Other Plans | $22 | 457% |
| Wppa (Providers Care)-All Plans | $26 | 541% |
Consumer Guidance & Cost Commentary
For the blood test for sodium (CPT code 84295) at Graham County Hospital in Hill City, Kansas, the cash price is $27.00, which matches the facility's listed gross charge. This cash rate is significantly lower than the median negotiated rate of $15.00 paid by insurance carriers, suggesting that patients with high-deductible plans or those without insurance may find paying out-of-pocket more cost-effective than using an in-network plan. While the facility is a Critical Access Hospital owned by the local government, the cash price remains consistent with the Medicare amount of $4.81 when adjusted for the 3.1x markup factor, indicating a pricing structure that aligns closely with federal benchmarks rather than commercial markups.
Patients should be aware that while the facility's cash rate is competitive, commercial payers like UnitedHealthcare, Blue Cross Blue Shield, and Medicaid/KanCare have negotiated rates ranging from $15.00 to $27.00 depending on the specific plan. It is important to verify your specific plan's allowed amount before scheduling, as assuming in-network status guarantees the lowest price can lead to unexpected costs if your deductible has not been met. If you choose to pay directly, ask the billing department about "self-pay" or "prompt-pay" discounts, which can further reduce the $27.00 cash price. Always request a detailed, itemized bill before finalizing payment to ensure no unbundled charges or services not rendered are included, as summary bills often obscure these potential errors.