Blood test, sodium
Facility: Medicine Lodge Memorial Hospital
Billing Code: 84295 (CPT)
- CPT Billing Code: 84295
- Insurance Median: $25
- Cash Discount Price: $27
- vs. Medicare Baseline: 5.20x 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 520% of the Medicare baseline (a markup of 420%). 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 |
|---|---|---|
| Tricare | $21 | 437% |
| Humana | $24 | 499% |
| Hpk-All Plans | $25 | 520% |
| UnitedHealthcare | $25 | 520% |
| Aetna | $25 - $27 | 520% |
| Medicaid / KanCare | $27 | 561% |
Consumer Guidance & Cost Commentary
For the blood test for sodium (CPT 84295) at Medicine Lodge Memorial Hospital in Medicine Lodge, KS, the facility's cash price is $27.00, which matches the state average. While the hospital's negotiated rates with major payers like Tricare and Humana are also $21.00 to $25.00, these amounts are generally higher than the cash price. For patients with high-deductible plans, paying the cash price of $27.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash rate. Patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill.
It is important to understand that commercial insurance rates are often inflated by administrative costs and contract structures, sometimes reaching 200% to 300% of the Medicare benchmark rate of $4.81 for this service. Although the facility is a Critical Access Hospital owned by a Government Hospital District, the negotiated rates do not reflect the lowest possible cost. If you receive a bill from an out-of-network provider or encounter unexpected charges, you have the right to dispute balance billing under the No Surprises Act, particularly for emergency care or non-emergency services at in-network facilities. Always request a full itemized bill before paying, as summary invoices can hide unbundled codes or services not rendered, and ensure any dispute is handled in writing to protect your rights.