Blood test, sodium
Facility: William Newton Hospital
Billing Code: 84295 (CPT)
- CPT Billing Code: 84295
- Insurance Median: $12
- Cash Discount Price: $33
- vs. Medicare Baseline: 2.49x 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 $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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| UnitedHealthcare | $2 - $30 | 42% |
| Blue Cross Blue Shield | $10 - $12 | 208% |
| Ambetter / Centene | $12 - $33 | 249% |
| Triwest- All Plans | $12 | 249% |
| Providrs Care Nexus | $20 | 416% |
| Providrs Care - All Other Plans | $23 | 478% |
Consumer Guidance & Cost Commentary
For this blood test for sodium at William Newton Hospital in Winfield, KS, the cash price is $33.00, which matches the facility's median negotiated rate. This service is significantly more expensive than the state average, with the Medicare benchmark set at $4.81. While commercial insurance plans like UnitedHealthcare and Blue Cross Blue Shield negotiate rates ranging from $10 to $33 depending on the specific plan, patients with high-deductible plans might find paying the cash price directly more cost-effective if their insurance allowed amount exceeds $33.00. It is important to verify your specific plan's allowed amount before scheduling, as assuming in-network coverage guarantees the lowest price can lead to unexpected costs.
To ensure you are not overcharged, request an itemized bill that breaks down the exact CPT code and unit costs, as summary bills often obscure individual charges. If you choose to pay out-of-pocket, ask the billing department about prompt-pay discounts, which can reduce the total by 20% to 50% if settled within 30 days. Additionally, be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under federal law, so you should dispute any surprise bills immediately rather than paying them in full. Always confirm your deductible status before using insurance for shoppable tests to avoid paying the full negotiated rate if your plan has not yet covered the service.