Blood test, comprehensive metabolic panel
Facility: William Newton Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $14
- Cash Discount Price: $36
- vs. Medicare Baseline: 1.33x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $10.56 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Triwest- All Plans | $1 - $24 | 9% |
| Ambetter / Centene | $1 - $70 | 9% |
| UnitedHealthcare | $1 - $63 | 9% |
| Blue Cross Blue Shield | $1 - $25 | 9% |
| Providrs Care - All Other Plans | $2 - $49 | 19% |
| Providrs Care Nexus | $2 - $43 | 19% |
Consumer Guidance & Cost Commentary
For a comprehensive metabolic panel at William Newton Hospital in Winfield, KS, the cash price is $36.00, which matches the facility's cash median. This rate is 30% higher than the Medicare benchmark of $10.56, indicating a markup typical of commercial pricing structures. While the facility is a Critical Access Hospital with government ownership, patients should note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. If you have a high-deductible plan, paying the $36.00 cash price upfront might be more cost-effective than relying on insurance, as the negotiated rate could result in higher out-of-pocket costs if your deductible is not yet met.
Before scheduling, it is crucial to verify your specific insurance plan's negotiated rate, as in-network status does not guarantee the lowest possible price. The data shows a range of negotiated amounts from $1 to $70 across various payers, meaning your specific plan could result in a significantly different bill than the median. To minimize costs, contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can reduce the final balance by 20% to 50% if paid in full within a short window. Additionally, ensure you request an itemized bill rather than a summary invoice to identify any errors or unbundled charges, as over 80% of hospital bills contain discrepancies that can be corrected through a formal written audit.