CMS Price Transparency Data

Blood test, sodium

Facility: St Clair Hospital

Billing Code: 84295 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84295
Insurance Median: $7
Cash Discount Price: $10
vs. Medicare Baseline: 1.46x Medicare

The contracted insurance negotiated median rate for a Blood test, sodium at St Clair Hospital is $7. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10. Compared to the federal Medicare reimbursement reference rate of $4.81, this hospital’s rate is 1.46x the Medicare baseline. Located in 1000 Bower Hill Road, Pittsburgh, PA.

Cash / Self-Pay

$10

Average discount available for prompt cash payment at this facility.

Insurance Median

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: $10 (208%)

Insurance Median: $7 (146%)

Cash: $10 (208% of Medicare)

Ins. Median: $7 (146% 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.

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
Highmark	$4 - $10	83%
Aetna	$5 - $13	104%
Amerihealth	$5 - $7	104%
Cigna	$5 - $7	104%
Geisinger	$5 - $7	104%
Health Partners	$5 - $7	104%
Humana	$5	104%
Pa Health And Wellness	$5 - $7	104%
The Health Plan	$5 - $12	104%
UnitedHealthcare	$5 - $7	104%
Upmc	$5 - $23	104%
Lantern	$10	208%

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 $10.
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 St Clair Hospital 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.