Blood test, sodium
Facility: Smith County Memorial Hospital
Billing Code: 84295 (CPT)
- CPT Billing Code: 84295
- Insurance Median: $19
- Cash Discount Price: $20
- vs. Medicare Baseline: 3.95x 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 395% of the Medicare baseline (a markup of 295%). 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 | 208% |
| Medicaid / KanCare | $14 - $20 | 291% |
| Multiplan-All Plans | $18 | 374% |
| Health Partners Of Ks Ppo-All Plans | $19 | 395% |
| Wppa-All Plans | $19 | 395% |
| Midlands Choice-All Plans | $19 | 395% |
| UnitedHealthcare | $19 | 395% |
Consumer Guidance & Cost Commentary
For this blood test procedure at Smith County Memorial Hospital in Smith Center, Kansas, the cash price is $20.00, which matches the facility's gross charge. While the hospital's negotiated rates with insurance payers average $19.00, this is slightly lower than the cash price. For patients with high-deductible plans, paying the full cash price of $20.00 upfront may be more cost-effective than relying on insurance, as the insurer's negotiated rate is not significantly lower. It is important to verify your specific plan's deductible status before scheduling, as paying out-of-pocket could save you money if your insurance has not yet covered this service.
The facility's cash rate of $20.00 is 4.0% higher than the Medicare benchmark of $19.00, which serves as a reliable baseline for evaluating pricing fairness. Although the hospital is a Critical Access Hospital owned by the local government, the cash price remains consistent across all payer types listed, ranging from $10 to $20 depending on the specific plan. Patients should contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full within a short window. Additionally, if you receive a bill from an out-of-network provider at this facility, you may be protected under the No Surprises Act, which prevents balance billing for emergency and non-emergency services.