Blood test, comprehensive metabolic panel
Facility: Mcpherson Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $55
- Cash Discount Price: $49
- vs. Medicare Baseline: 5.21x 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 521% of the Medicare baseline (a markup of 421%). 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 |
|---|---|---|
| Tricare | $9 | 85% |
| Healthy Blue Mcr Adv | $11 | 104% |
| Va Ccn - All Plans | $11 | 104% |
| Blue Cross Blue Shield | $11 | 104% |
| UnitedHealthcare | $11 - $246 | 104% |
| Humana | $11 | 104% |
| Wellcare Mcr Adv - All Plans | $11 | 104% |
| Ambetter / Centene | $12 | 114% |
| Wppa - All Plans | $38 - $172 | 360% |
| Central Plains - All Plans | $41 - $184 | 388% |
| Medical Associates - All Plans | $41 - $184 | 388% |
| Christian Health Aid - All Plans | $44 - $197 | 417% |
| Aetna | $45 - $246 | 426% |
| Multiplan - All Plans | $50 - $221 | 473% |
| First Health - All Plans | $52 - $234 | 492% |
| Health Partners - All Plans | $52 - $234 | 492% |
| Cigna | $52 - $234 | 492% |
| Medicaid / KanCare | $55 - $246 | 521% |
| Health Blue Mcaid - All Other Plans | $56 - $251 | 530% |
Consumer Guidance & Cost Commentary
For CPT code 80053, a comprehensive metabolic panel, McPherson Hospital in McPherson, KS, lists a gross charge of $66.00. The facility's cash median price is $49.00, which is lower than the negotiated rates paid by most major payers, ranging from $52.00 to $56.00. While the facility's negotiated rate of $55.00 is slightly higher than the cash price, patients with high-deductible plans may find paying the cash median of $49.00 more cost-effective if their insurance allowed amount exceeds this figure. It is important to note that commercial rates often include administrative overhead and do not reflect the true cost of care, which is better understood by comparing against the Medicare benchmark of $10.56.
Patients should be aware that balance billing can occur if they receive care from out-of-network providers, though the No Surprises Act protects against surprise bills for emergency services at in-network facilities. To avoid unexpected costs, consumers should request an itemized billing audit to ensure no unbundled codes or services not rendered are included in the final invoice. Additionally, asking about self-pay or prompt-pay discounts before scheduling can result in significant savings, as hospitals often offer reductions for upfront payments to bypass costly claims processing. Given that over 80% of hospital bills contain errors, verifying the final statement with a certified written dispute is a critical step in managing medical debt.