Blood test, sodium
Facility: Girard Medical Center
Billing Code: 84295 (CPT)
- CPT Billing Code: 84295
- Insurance Median: $25
- Cash Discount Price: $42
- 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 |
|---|---|---|
| Blue Cross Blue Shield | $10 - $24 | 208% |
| Aetna | $24 - $122 | 499% |
| UnitedHealthcare | $24 - $66 | 499% |
| Humana | $24 | 499% |
| Ambetter / Centene | $24 | 499% |
| Kansas Superior Select-All Plans | $24 | 499% |
| Medicare (plans) | $24 | 499% |
| Multiplan-All Plans | $65 | 1351% |
| Uhhis-All Plans | $66 | 1372% |
Consumer Guidance & Cost Commentary
For this blood test at Girard Medical Center, the cash price of $42.00 is notably lower than the facility's negotiated rates, which range from $24.00 to $122.00 depending on the insurance plan. While the median negotiated amount paid by insurers is $25.00, patients with high-deductible plans may find paying the cash price directly more cost-effective if their insurance allows a higher allowed amount than the cash rate. It is important to note that while the facility's cash rate is competitive, the negotiated rates for in-network plans can vary significantly, with some plans paying up to $122.00 for this service.
To ensure you are not overcharged, always request a full itemized bill before finalizing payment, as summary bills often obscure individual line items and potential errors. If you receive a balance bill for the difference between the provider's chargemaster and your insurance payment, remember that the No Surprises Act generally protects you from these unexpected charges for emergency care and non-emergency services at in-network facilities. Additionally, you should inquire about prompt-pay discounts, which can reduce your bill by 20% to 50% if settled upfront, and verify that your facility's pricing aligns with state or county averages to confirm fair market value.