CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Madison County Health Care System

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $193
Cash Discount Price: $238
vs. Medicare Baseline: 18.28x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Madison County Health Care System is $193. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $238. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 18.28x the Medicare baseline. Located in 300 West Hutchings Street, Winterset, IA.

Cash / Self-Pay

$238

Average discount available for prompt cash payment at this facility.

Insurance Median

$193

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.56 (100%)

Cash / Self-Pay: $238 (2254%)

Insurance Median: $193 (1828%)

Cash: $238 (2254% of Medicare)

Ins. Median: $193 (1828% of 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1828% of the Medicare baseline (a markup of 1728%). 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
Blue Cross Blue Shield	$52 - $57	492%
Aetna	$128 - $193	1212%
Medical Associates Hp - All Plans	$128	1212%
Medigold-All Plans	$128	1212%
Tricare	$128	1212%
UnitedHealthcare	$128 - $267	1212%
American Hp Mcr Adv-All Plans	$134	1269%
Iowa Total Care Mcaid-All Plans	$140	1326%
Molina Mcaid/Chip -All Plans	$144	1364%
Amerigroup Mcaid-All Plans	$148	1402%
Madison County Sheriff-All Plans	$148	1402%
Oscar - All Plans	$192	1818%
Corvel Wc-All Plans	$267	2528%
Choicecare-All Plans	$282	2670%
First Choice-All Plans	$282	2670%
First Health-All Plans	$282	2670%
Integrated Hp-All Plans	$282	2670%
Mutual Of Omaha-All Plans	$282	2670%
Plaines Health-All Plans	$282	2670%
Preferred Hlth Ntwork-All Plans	$282	2670%
Principal Healthcare-All Plans	$282	2670%
Usa Managed Care-All Plans	$282	2670%
Medimore Employee Hp - All Plans	$291	2756%
Midlands Choice - All Plans	$291	2756%
Benefit Admin Of America-All Plans	$297	2813%

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 $238.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 80053.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Madison County Health Care System is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 80053.
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.