CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Monroe County Hospital

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $37
Cash Discount Price: $37
vs. Medicare Baseline: 3.50x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Monroe County Hospital is $37. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $37. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 3.50x the Medicare baseline. Located in 6580 165Th Street, Albia, IA.

Cash / Self-Pay

$37

Average discount available for prompt cash payment at this facility.

Insurance Median

$37

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: $37 (350%)

Insurance Median: $37 (350%)

Cash: $37 (350% of Medicare)

Ins. Median: $37 (350% 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 350% of the Medicare baseline (a markup of 250%). 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
Va Ccn - All Plans	$4 - $20	38%
Wellmark Hmo	$10	95%
Wellmark Ppo - All Other Plans	$11	104%
Mahp Mcare - All Plans	$16 - $80	152%
Tricare	$16 - $80	152%
UnitedHealthcare	$16 - $180	152%
Aetna	$17 - $179	161%
Amerigroup Mcare	$17 - $81	161%
Humana	$17 - $81	161%
Wellmark Mcare	$17 - $81	161%
Iowa Total Care Mcaid - All Plans	$19 - $95	180%
Amerigroup Mcaid - All Other Plans	$20 - $98	189%
Molina Mcaid - All Plans	$20 - $96	189%
Centivo - All Plans	$25 - $120	237%
Midlands Choice - All Plans	$27 - $133	256%
Preferred Hlth - All Plans	$29 - $142	275%
Geha - All Plans	$31 - $152	294%
Multiplan - All Plans	$35 - $171	331%
Integrated Hp - All Plans	$38 - $184	360%

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 $37.
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 Monroe County Hospital 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.