CMS Price Transparency Data

Blood test, sodium

Facility: Mercy Hospital Carthage

Billing Code: 84295 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84295
Insurance Median: $42
Cash Discount Price: $50
vs. Medicare Baseline: 8.73x Medicare

The contracted insurance negotiated median rate for a Blood test, sodium at Mercy Hospital Carthage is $42. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $50. Compared to the federal Medicare reimbursement reference rate of $4.81, this hospital’s rate is 8.73x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.

Cash / Self-Pay

$50

Average discount available for prompt cash payment at this facility.

Insurance Median

$42

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$4.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $4.81 (100%)

Cash / Self-Pay: $50 (1040%)

Insurance Median: $42 (873%)

Cash: $50 (1040% of Medicare)

Ins. Median: $42 (873% of 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 873% of the Medicare baseline (a markup of 773%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$4 - $69	83%
Blue Cross Blue Shield	$4 - $21	83%
Humana	$4 - $23	83%
Medicaid / KanCare	$4 - $42	83%
Medicare (plans)	$5 - $23	104%
United Medical Resources Contracted [320454]	$7 - $69	146%
UnitedHealthcare	$7 - $67	146%
Cherokee Nation Health Serv Contracted [320066]	$21	437%
Cigna	$21 - $69	437%
Cross Timbers Hospice [20098]	$21	437%
Dept Of Veteran Affairs Contracted [320106]	$21	437%
Elara Caring Aspire Hospice [20433]	$21	437%
Globalhealth Contracted [320145]	$21	437%
Halo Hcr Inc Hospice Contracted [320432]	$21	437%
Halo Hcr Inc Hospice [20432]	$21	437%
Indian Health Service Contracted [320198]	$21	437%
Kindful Hospice Contracted [320434]	$21	437%
Kindful Hospice [20434]	$21	437%
Medical Associates Health Contracted [320444]	$21	437%
Mercy Hospice Okc [20252]	$21	437%
Mercy Mgd Behavioral Health Contracted [320259]	$21	437%
Pace Of The Ozarks Contracted [320518]	$21	437%
Provider Partners Health Plans Contracted [320450]	$21	437%
Qual Choice Contracted [320325]	$21	437%
Tricare	$21	437%
Point C Contracted [320238]	$27 - $69	561%
Health Systems Inc Contracted [320174]	$33	686%
Insurance System Inc Contracted [320465]	$33	686%
Administrative Payor Contracted [320005]	$35	728%
Centivo Contracted [320505]	$35	728%
Healthscope Contracted [320182]	$40	832%
Ambetter / Centene	$42	873%
Home State Health Plan Contracted [320187]	$42	873%
Novasys Contracted [320285]	$42	873%
Benefit Management Contracted [320052]	$46 - $67	956%
Auxiant Contracted [320462]	$50 - $65	1040%
Healthlink Contracted [320179]	$50 - $72	1040%
Preferred Health Plan Contracted [320522]	$50	1040%
Workers Comp [20426]	$62 - $77	1289%
90 Degree Benefits Contracted [320436]	$65	1351%
Aither Health Contracted [320449]	$65	1351%
Ebms Contracted [320493]	$65	1351%
Edison Health Solutions Contracted [320502]	$65	1351%
Imagine 360 Contracted [320494]	$65	1351%
Mercy Benefit Admin Contracted [320251]	$65 - $69	1351%
Reflect Health Contracted [320492]	$65	1351%
Show-Me Health Administrators Contracted [320483]	$65	1351%
Yuzu Health Contracted [320521]	$65	1351%
Evolutions Health Care Contracted [320124]	$67	1393%
First Health Contracted [320128]	$67	1393%
Medica Contracted [320239]	$67	1393%
Multiplan Contracted [320270]	$67	1393%
Private Health Care Systems Contracted [320320]	$67	1393%
American Healthcare Alliance Contracted [320020]	$69	1435%
Ppo Plus Contracted [320310]	$69	1435%
Usa Managed Care Org Contracted [320429]	$69	1435%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $50.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 84295.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mercy Hospital Carthage is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 84295.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.