CMS Price Transparency Data

Blood test, sodium

Facility: UPMC Presbyterian Shadyside

Billing Code: 84295 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84295
Insurance Median: $42
Cash Discount Price: $215
vs. Medicare Baseline: 8.73x Medicare

The contracted insurance negotiated median rate for a Blood test, sodium at UPMC Presbyterian Shadyside is $42. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $215. Compared to the federal Medicare reimbursement reference rate of $4.81, this hospital’s rate is 8.73x the Medicare baseline. Located in 200 Lothrop Street, Pittsburgh, PA.

Cash / Self-Pay

$215

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: $215 (4470%)

Insurance Median: $42 (873%)

Cash: $215 (4470% 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	$5 - $8	104%
Amerihealth Caritas	$5 - $10	104%
Cigna	$5	104%
Highmark Wholecare (Prev Gateway)	$5 - $10	104%
Pa Health & Wellness	$5 - $11	104%
UnitedHealthcare	$5 - $8	104%
Upmc Work Partners	$5	104%
Health Partners Plans (Jefferson Health Plan)	$6	125%
Multiplan	$6 - $287	125%
Upmc Health Plan	$7 - $10	146%
Blue Cross Blue Shield	$9 - $42	187%
Geisinger	$10	208%
Preferred Healthcare System	$233	4844%
Coventry/First Health	$251	5218%
Fidelis	$269	5593%
Intergroup	$269 - $305	5593%
Health Coalition Partners	$287	5967%
Private Health Care Systems	$287	5967%
Selectcare	$287	5967%
Health Payors Organization	$305	6341%
Humana	$305	6341%

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 $215.
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 UPMC Presbyterian Shadyside 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.