CMS Price Transparency Data

Blood test, sodium

Facility: Elmhurst Hospital Center

Billing Code: 84295 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84295
Insurance Median: $25
Cash Discount Price: Unavailable
vs. Medicare Baseline: 5.20x Medicare

The contracted insurance negotiated median rate for a Blood test, sodium at Elmhurst Hospital Center is $25. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $4.81, this hospital’s rate is 5.20x the Medicare baseline. Located in 79-01 Broadway, Elmhurst, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$25

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%)

Insurance Median: $25 (520%)

Ins. Median: $25 (520% 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 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.

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 - $14	83%
Healthfirst	$4 - $55	83%
Elderplan	$5	104%
Fidelis	$5 - $55	104%
Magnacare	$6	125%
Oscar	$7	146%
Oxford	$7	146%
United	$7 - $31	146%
Centerlight	$10	208%
Cigna	$12	249%
Wellcare	$12	249%
Carelon	$13 - $25	270%
Emblem	$14 - $33	291%
Blue Cross Blue Shield	$16 - $55	333%
Multiplan	$16	333%
Local 1199	$17	353%
Villagecare Max	$17	353%
Vnsny	$17 - $25	353%
Metroplus	$24 - $55	499%
Affinity	$25 - $55	520%
Amidacare	$25	520%
Carelon (Amida Care)	$25	520%
Senior Whole Health	$25	520%
United Behavioral Health	$25 - $27	520%

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 $X.
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 Elmhurst Hospital Center 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.