Blood test, comprehensive metabolic panel
Facility: Nmc Health
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $125
- Cash Discount Price: $135
- vs. Medicare Baseline: 11.84x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 1184% of the Medicare baseline (a markup of 1084%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | $23 | 218% |
| Aetna | $33 - $159 | 313% |
| Wppa | $106 | 1004% |
| Occunet | $116 | 1098% |
| Medincrease Health Plan | $125 | 1184% |
| Samaritan Ministries International | $125 | 1184% |
| Prime Health Services | $145 | 1373% |
| UnitedHealthcare | $174 | 1648% |
| Cigna | $183 | 1733% |
Consumer Guidance & Cost Commentary
For the comprehensive metabolic panel (CPT 80053) at Nmc Health in Newton, KS, the cash median price is $135.00, which is lower than the facility's negotiated rates of $125.00 to $183.00 across nine different payers. While commercial insurance contracts often result in higher allowed amounts due to administrative processing costs, patients with high-deductible plans may find paying cash directly more cost-effective if their insurance negotiated rate exceeds the cash price. It is important to note that the facility's cash rate is significantly lower than the gross charge of $193.00, and patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling to ensure they receive the best possible rate.
This service is priced at 11.8% above the Medicare benchmark of $10.56, which serves as a scientifically validated baseline for the true cost of care delivery. Although the facility is a voluntary non-profit Acute Care Hospital with a 5-star rating, commercial rates can vary widely; for instance, Blue Cross Blue Shield has a single plan paying $23.00, while UnitedHealthcare pays $174.00. To avoid unexpected costs, patients should verify their specific plan's allowed amount and check for any "prompt-pay" incentives that could reduce the final balance, as hospitals often offer significant discounts for upfront payment to bypass costly claims processing.