Blood test, sodium
Facility: Decatur Health
Billing Code: 84295 (CPT)
- CPT Billing Code: 84295
- Insurance Median: $14
- Cash Discount Price: $17
- vs. Medicare Baseline: 2.91x 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 291% of the Medicare baseline (a markup of 191%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $11 | 229% |
| UnitedHealthcare | $11 - $14 | 229% |
| Humana | $12 | 249% |
| Blue Cross Blue Shield | $13 | 270% |
| Midlands Choice- All Plans | $17 | 353% |
| Aetna | $17 - $19 | 353% |
| Medicaid / KanCare | $19 | 395% |
Consumer Guidance & Cost Commentary
For this blood test for sodium at Decatur Health in Oberlin, Kansas, the cash price of $17.00 is lower than the facility's negotiated rates with major insurers like UnitedHealthcare ($11–$14) and Aetna ($17–$19). While the facility's cash rate is slightly higher than the state average of $13.00, patients with high-deductible plans may find paying out-of-pocket cheaper if their insurance negotiated rate exceeds $17.00. It is important to verify your specific plan's allowed amount before scheduling, as commercial rates often include administrative costs that can inflate the final bill. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the total cost by offering immediate liquidity incentives that bypass standard insurance billing cycles.
When reviewing your bill, ensure you receive a detailed itemized statement rather than a summary invoice, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. If you receive a balance bill for services rendered at an in-network facility, you may have rights under the No Surprises Act to dispute the charges, particularly if out-of-network ancillary services were involved. For context, this service's Medicare benchmark is $4.81, which serves as a scientifically validated baseline for the true cost of care; commercial rates are often significantly higher than this figure. Always request a full CPT-coded audit before agreeing to any payment plan or signing waivers that might waive your protections against surprise billing.