CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Kirby Medical Center

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $186
Cash Discount Price: $223
vs. Medicare Baseline: 17.61x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Kirby Medical Center is $186. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $223. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 17.61x the Medicare baseline. Located in 1000 Medical Center Drive, Monticello, IL.

Cash / Self-Pay

$223

Average discount available for prompt cash payment at this facility.

Insurance Median

$186

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: $223 (2112%)

Insurance Median: $186 (1761%)

Cash: $223 (2112% of Medicare)

Ins. Median: $186 (1761% 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 1761% of the Medicare baseline (a markup of 1661%). 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
UnitedHealthcare	$9 - $256	85%
Aetna	$10 - $260	95%
Blue Cross Blue Shield	$10 - $365	95%
Meridian	$10 - $115	95%
Molina	$11 - $119	104%
Humana	$14 - $279	133%
Wellcare	$115	1089%
Cigna	$298	2822%
Catepillar, Inc.	$316	2992%
Healthlink	$335	3172%
Zelis (Hfn)	$335	3172%
Multiplan/Phcs	$353	3343%

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 $223.
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 Kirby Medical Center 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.