Blood test, urea nitrogen (BUN, kidney)
Facility: Graham County Hospital
Billing Code: 84520 (CPT)
- CPT Billing Code: 84520
- Insurance Median: $18
- Cash Discount Price: $24
- vs. Medicare Baseline: 4.56x 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 $3.95 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 456% of the Medicare baseline (a markup of 356%). 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 |
|---|---|---|
| Medicaid / KanCare | $6 | 152% |
| UnitedHealthcare | $6 - $23 | 152% |
| Blue Cross Blue Shield | $8 | 203% |
| Medicare (plans) | $18 | 456% |
| Celtic Commercial-All Other Plans | $20 | 506% |
| Wppa (Providers Care)-All Plans | $23 | 582% |
Consumer Guidance & Cost Commentary
For this blood test procedure at Graham County Hospital in Hill City, Kansas, the cash price of $24.00 is significantly lower than the facility's negotiated rates with major payers, which range from $6 to $23 depending on the specific plan. While the cash price matches the facility's cash median, it is notably higher than the state average for this service, suggesting that patients with high-deductible plans might save money by paying out-of-pocket rather than relying on insurance, especially since the negotiated rates for some commercial plans exceed the cash price. It is important to note that while the facility is a Critical Access Hospital owned by the local government, patients should always confirm their specific plan's coverage and any applicable "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can reduce the final bill.
The data indicates that Medicare, which serves as a benchmark for fair pricing, allows only $3.95 for this test, highlighting a substantial markup in both cash and commercial settings. Although the facility's cash rate is higher than the Medicare amount, it remains below the highest negotiated rates found for UnitedHealthcare and Wppa plans, illustrating the complexity of commercial pricing. Patients should be aware that balance billing is generally prohibited for emergency services at in-network facilities under federal law, but unexpected charges can still occur if ancillary services are out-of-network. To ensure accuracy, consumers should request a full itemized bill to verify that no unbundled codes or services not rendered have been included, as over 80% of hospital bills contain errors that can be corrected through a formal audit dispute.