Blood test, sodium
Facility: Memorial Hospital
Billing Code: 84295 (CPT)
- CPT Billing Code: 84295
- Insurance Median: $31
- Cash Discount Price: $57
- vs. Medicare Baseline: 6.44x 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 644% of the Medicare baseline (a markup of 544%). 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 | $7 | 146% |
| Tricare | $28 | 582% |
| Humana | $28 | 582% |
| Medicare (plans) | $29 | 603% |
| Ambetter / Centene | $31 | 644% |
| Coventry - All Other Plans | $51 | 1060% |
| Preferred Healthcare-All Plans | $54 | 1123% |
| Health Partners Of Kansas - All Plans | $54 | 1123% |
| Wppa/Providers Care-All Plans | $79 | 1642% |
Consumer Guidance & Cost Commentary
For this blood test for sodium at Memorial Hospital in Abilene, KS, the cash price is $57.00, which matches the facility's gross charge and the median cash rate reported for this service. While the hospital's negotiated rates with insurance payers range from $7 to $79, the median negotiated amount is $31.00, indicating that paying out-of-pocket may not always be the most cost-effective option for patients with high-deductible plans. It is important to note that commercial insurance contracts often include administrative overhead and multi-layered pricing structures that can result in negotiated rates exceeding the cash price, so patients should verify their specific plan's allowed amount before scheduling. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront, bypassing the costly claims processing cycle.
When evaluating the value of this service, it is essential to compare rates against federal benchmarks rather than the hospital's inflated chargemaster list. The Medicare amount for this procedure is $4.81, and the facility's negotiated rate of $31.00 represents a significant markup above this federal baseline, which is calculated based on actual provider costs plus a small margin. While the data does not provide specific state or county average rates for comparison, the facility operates as a Critical Access Hospital in a government-owned district, which may influence its pricing strategy. Consumers should be aware that balance billing is generally prohibited for emergency care and non-emergency services from out-of-network providers at in-network facilities under the No Surprises Act, and they should request a full itemized bill to ensure