CMS Price Transparency Data

Blood test, sodium

Facility: Sanford Clear Lake Medical Center

Billing Code: 84295 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 84295
Insurance Median: $41
Cash Discount Price: $40
vs. Medicare Baseline: 8.52x Medicare

The contracted insurance negotiated median rate for a Blood test, sodium at Sanford Clear Lake Medical Center is $41. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $40. Compared to the federal Medicare reimbursement reference rate of $4.81, this hospital’s rate is 8.52x the Medicare baseline. Located in 701 Third Avenue South, Clear Lake, SD.

Cash / Self-Pay

$40

Average discount available for prompt cash payment at this facility.

Insurance Median

$41

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: $40 (832%)

Insurance Median: $41 (852%)

Cash: $40 (832% of Medicare)

Ins. Median: $41 (852% 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 852% of the Medicare baseline (a markup of 752%). 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
Sanford Health Plan Align	$26	541%
Aetna	$28 - $43	582%
Health Partners	$28 - $38	582%
Medicare (plans)	$28	582%
Primewest	$28	582%
Security Health Plan	$28	582%
Ucare	$28 - $44	582%
UnitedHealthcare	$28 - $42	582%
Wellmark Sd	$28	582%
Sanford Health Plan	$35 - $46	728%
Blue Cross Blue Shield	$41 - $46	852%
Medica	$41 - $44	852%
Wellmark	$43 - $44	894%
Cigna	$45	936%
First Choice Health Network	$45	936%
Healthez	$45	936%
Multiplan	$45	936%

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 $40.
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 Sanford Clear Lake Medical 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.