CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Boone County Hospital

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $111
Cash Discount Price: $198
vs. Medicare Baseline: 10.51x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Boone County Hospital is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $198. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 10.51x the Medicare baseline. Located in 1015 Union Street, Boone, IA.

Cash / Self-Pay

$198

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $198 (1875%)

Insurance Median: $111 (1051%)

Cash: $198 (1875% of Medicare)

Ins. Median: $111 (1051% 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 1051% of the Medicare baseline (a markup of 951%). 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
Tricare	$11	104%
Va Ccn-All Plans	$26	246%
Wellmark Hmo	$52	492%
Wellmark Ppo - All Other Plans	$57	540%
Choice Care Mcr Adv - All Plans	$101	956%
Humana	$101 - $223	956%
Iowa Hlth Adv - All Plans	$101	956%
Mt Carmel Hp - All Plans	$101	956%
UnitedHealthcare	$101 - $145	956%
Amerigroup Mcr Adv - All Other Plans	$102	966%
Aetna	$104 - $193	985%
Meridian Mcaid - All Plans	$111	1051%
Iowa Total Care Mcaid - All Plans	$114	1080%
Medicaid / KanCare	$115	1089%
Healthsmart Accell Network	$173	1638%
Medical Associates Hp-All Plans	$186	1761%
Healthsmart Ppo - All Other Plans	$198	1875%
Health Alliance-All Plans	$223	2112%
Midlands Choice-All Plans	$228	2159%
Mutually Preferred-All Plans	$235	2225%

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 $198.
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 Boone 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.