Blood test, potassium
Facility: Ellsworth County Medical Center
Billing Code: 84132 (CPT)
- CPT Billing Code: 84132
- Insurance Median: $36
- Cash Discount Price: $40
- vs. Medicare Baseline: 7.56x 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 $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 756% of the Medicare baseline (a markup of 656%). 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 | $9 - $10 | 189% |
| Humana | $19 - $38 | 399% |
| Healthy Blue Mcr Adv | $19 | 399% |
| Triwest -All Plans | $19 | 399% |
| Va Ccn-All Plans | $19 | 399% |
| UnitedHealthcare | $26 - $40 | 546% |
| First Health - All Plans | $36 | 756% |
| Aetna | $36 | 756% |
| Cigna | $38 | 798% |
| Coventry Mcaid-All Plans | $40 | 840% |
| Medicaid / KanCare | $40 | 840% |
| Healthy Blue Mcaid- All Other Plans | $40 | 840% |
| Providers Care-Wppa-All Plans | $59 | 1239% |
Consumer Guidance & Cost Commentary
For this blood test, the facility's cash price of $40.00 matches the highest negotiated rate paid by UnitedHealthcare and several other payers, while the median negotiated rate across all 13 insurance plans is $36.00. This indicates that for patients with high-deductible plans, paying cash directly may be more cost-effective than relying on insurance, as the commercial negotiated rates often exceed the cash price due to administrative overhead and contract structures. To secure the lowest possible amount, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront, bypassing the costly claims processing cycle that inflates insurance rates.
When evaluating the cost relative to government benchmarks, the Medicare amount for this service is $4.76, which serves as the objective baseline for fair pricing. The facility's cash rate of $40.00 represents a significant markup compared to this federal standard, a common practice where commercial rates average 200% to 300% of Medicare rates. While the data does not provide specific state or county average figures for comparison, the facility is a Critical Access Hospital in Ellsworth, Kansas, and patients should be aware that commercial rates often include additional layers of cost such as claims management and utilization reviews that are not reflected in the Medicare calculation.