CMS Price Transparency Data
Blood test, sodium
Facility: Saint Alphonsus Medical Center Ontario
Billing Code: 84295 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 84295
- Insurance Median: $12
- Cash Discount Price: $26
- vs. Medicare Baseline: 2.49x Medicare
The contracted insurance negotiated median rate for a Blood test, sodium at Saint Alphonsus Medical Center Ontario is $12. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $26. Compared to the federal Medicare reimbursement reference rate of $4.81, this hospital’s rate is 2.49x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.
Cash / Self-Pay
$26
Average discount available for prompt cash payment at this facility.
Insurance Median
$12
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: $26 (541%)
Insurance Median: $12 (249%)
Cash: $26 (541% of Medicare)
Ins. Median: $12 (249% 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 249% of the Medicare baseline (a markup of 149%). 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $3 - $12 | 62% |
| Aetna | $5 - $38 | 104% |
| American Health Advantage Of Idaho | $5 | 104% |
| Blue Cross Blue Shield | $5 - $34 | 104% |
| Healthnet | $5 | 104% |
| Medicare (plans) | $5 | 104% |
| UnitedHealthcare | $5 - $38 | 104% |
| Moda Health | $9 - $39 | 187% |
| Ada County Jail Inmate Ins | $12 | 249% |
| Ambetter / Centene | $12 | 249% |
| Amish Mennonite | $12 | 249% |
| Bcccp-Michigan | $12 | 249% |
| Bccp | $12 | 249% |
| Bmc Healthnet | $12 | 249% |
| Breast Grant-Connecticut | $12 | 249% |
| California Health And Wellness | $12 | 249% |
| Cardinal Innovations Lme | $12 | 249% |
| Care Oregon Ohp | $12 | 249% |
| Cencal Health Plan | $12 | 249% |
| Cenpatico | $12 | 249% |
| Centurion Of Idaho | $12 | 249% |
| Chhuny | $12 | 249% |
| Childrens Comm Health Plan | $12 | 249% |
| Childrens Medical Services Title 19 | $12 | 249% |
| Cigna | $12 - $38 | 249% |
| Community Benefit Health | $12 | 249% |
| Community Care Behavorial Health | $12 | 249% |
| Community Health Choice | $12 | 249% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $12 | 249% |
| Dean Wi Badgercare | $12 | 249% |
| Delaware First Health | $12 | 249% |
| Delta Dental Nj | $12 | 249% |
| Dph Tb Program | $12 | 249% |
| Dscc | $12 | 249% |
| Eastpointe Lme | $12 | 249% |
| Family Health Network | $12 | 249% |
| Freedom First Healthcare | $12 | 249% |
| Ghc Scw Wi Badgercare | $12 | 249% |
| Harbor Health | $12 | 249% |
| Health Safety Net | $12 | 249% |
| Healthy Blue Ne | $12 | 249% |
| Hennepin Health | $12 | 249% |
| Humana | $12 - $35 | 249% |
| Id County Ada | $12 | 249% |
| Id County Canyon | $12 | 249% |
| Id County Cat Fund | $12 | 249% |
| Id County Payette | $12 | 249% |
| Idaho Womens Health Check | $12 | 249% |
| Indiana Breast Cervical Cancer | $12 | 249% |
| Inland Empire Health Plan | $12 | 249% |
| Intercommunity Health Ohp | $12 | 249% |
| Iowa Total Care | $12 | 249% |
| Jai Medical System | $12 | 249% |
| Kern Family Health Plan | $12 | 249% |
| Keystone First | $12 | 249% |
| Keystone First Chip | $12 | 249% |
| La Care Health Plan | $12 | 249% |
| Lakeland Care Inc | $12 | 249% |
| Managed Health Services - Indiana | $12 | 249% |
| Maryland Breast & Cervical Program | $12 | 249% |
| Maryland Healthy Smiles - Scion Dental | $12 | 249% |
| Maryland Physicians Care | $12 | 249% |
| Massachusetts Behavioral Health Partnership | $12 | 249% |
| Mdwise | $12 | 249% |
| Medi-Cal | $12 | 249% |
| Medi-Cal Healthnet | $12 | 249% |
| Medstar Dc Healthy Family | $12 | 249% |
| Medstar Md Health Choice | $12 | 249% |
| Mo Home State Health Plan | $12 | 249% |
| Molina Centennial Care | $12 | 249% |
| Nascentia Health Options | $12 | 249% |
| Nebraska Total Care | $12 | 249% |
| New York Cancer Services Program | $12 | 249% |
| Nextlevel Health | $12 | 249% |
| Oregon Screenwise | $12 | 249% |
| Pace Of Southwest Michigan | $12 | 249% |
| Paramount Advantage | $12 | 249% |
| Parkland Community Health Plan | $12 | 249% |
| Partners Behavioral Lme | $12 | 249% |
| Peach State Healthplan | $12 | 249% |
| Presbyterian Centennial Care | $12 | 249% |
| Prestige Health Choice | $12 | 249% |
| Priority Partners | $12 | 249% |
| Rx 340B Pass Along | $12 | 249% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $12 | 249% |
| Rx Medi-Cal | $12 | 249% |
| Rx Meridian Rx | $12 | 249% |
| Sandhills Center Lme | $12 | 249% |
| Screening For Life | $12 | 249% |
| Sunshine State Health Plan | $12 | 249% |
| Superior Health | $12 | 249% |
| Tenncare | $12 | 249% |
| Texas Children'S Health Plan | $12 | 249% |
| Trillium Community Ohp | $12 | 249% |
| Tufts Health Public Plans | $12 | 249% |
| Vaya Health Lme | $12 | 249% |
| Wellsense Health Plan | $12 | 249% |
| Wi Womens Wellness | $12 | 249% |
| Webtpa | $13 - $36 | 270% |
| Selecthealth | $15 - $36 | 312% |
| Mountain Health Co-Op | $24 | 499% |
| Pacificsource Health Plans | $24 - $38 | 499% |
| Allegiance | $30 | 624% |
| Correctional Health Partners | $31 | 644% |
| Columbia Health Network | $32 | 665% |
| Allied National Global Care | $36 | 748% |
| Asrm - Reliance Standard Life Insurance | $36 | 748% |
| Christian Care Ministry | $36 | 748% |
| Dean Health | $36 | 748% |
| Fallon Health | $36 | 748% |
| Family Life Insurance Company | $36 | 748% |
| First Choice Health | $36 | 748% |
| Ghc Scw | $36 | 748% |
| International Benefit Administrators | $36 | 748% |
| Lifetime Benefit Solutions | $36 | 748% |
| Manhattan Life | $36 | 748% |
| Pai | $36 | 748% |
| Pan-American Life | $36 | 748% |
| Paramount Hmo | $36 | 748% |
| Phcs | $36 | 748% |
| Trinity Health Share | $36 | 748% |
| Lifewise | $37 | 769% |
| Allied Benefit Systems | $38 | 790% |
| Ameriben | $38 | 790% |
| Asr Health Benefits | $38 | 790% |
| Christian Brother Services | $38 | 790% |
| Geha | $38 | 790% |
| Healthez | $38 | 790% |
| Luminare Health (Detroit) | $38 | 790% |
| Priority Health | $38 | 790% |
| Providence | $38 | 790% |
| Rural Carrier Health Benefit Plan | $38 | 790% |