CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Hamilton Memorial Hospital

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $290
Cash Discount Price: $308
vs. Medicare Baseline: 27.46x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Hamilton Memorial Hospital is $290. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $308. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 27.46x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$308

Average discount available for prompt cash payment at this facility.

Insurance Median

$290

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: $308 (2917%)

Insurance Median: $290 (2746%)

Cash: $308 (2917% of Medicare)

Ins. Median: $290 (2746% 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 2746% of the Medicare baseline (a markup of 2646%). 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
Medicaid / KanCare	$135 - $145	1278%
Blue Cross Blue Shield	$138 - $330	1307%
Aetna	$145 - $326	1373%
Health Alliance	$145 - $290	1373%
Humana	$145	1373%
Medicare (plans)	$145	1373%
UnitedHealthcare	$145 - $259	1373%
Wellcare	$145	1373%
Alliance Coal	$254	2405%
Healthscope	$254	2405%
Wellfirst (Ssmhic)	$254	2405%
Hope Trust	$272	2576%
Cigna	$284	2689%
Hfn, Inc	$290 - $326	2746%
Healthlink	$308 - $326	2917%
Multiplan	$308	2917%
Siho	$326	3087%
Three Rivers Provider	$326	3087%
Healthsmart	$344	3258%
Stratose	$344	3258%

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 $308.
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 Hamilton Memorial 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.