Blood test, comprehensive metabolic panel
Facility: Ellinwood District Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $44
- Cash Discount Price: $53
- vs. Medicare Baseline: 4.17x 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 417% of the Medicare baseline (a markup of 317%). 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 | $44 | 417% |
| UnitedHealthcare | $44 | 417% |
| Cigna | $44 | 417% |
| Aetna | $44 | 417% |
| Humana | $44 | 417% |
Consumer Guidance & Cost Commentary
For the comprehensive metabolic panel at Ellinwood District Hospital, the cash price of $53.00 is notably lower than the median negotiated rate of $44.00 paid by major insurers like Blue Cross Blue Shield and UnitedHealthcare. This price difference highlights a common billing dynamic where cash-pay options can be more affordable than insurance-covered services, particularly for patients with high-deductible plans who may face out-of-pocket costs exceeding the cash price. While the facility's cash rate is competitive, it is important to note that commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the final amount billed to an insured patient compared to a direct cash payment.
To ensure you are not overcharged, we recommend requesting an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, since this is a Critical Access Hospital in Kansas, you should verify if "self-pay" or "prompt-pay" discounts are available, which could further reduce the $53.00 cash price. When evaluating the facility's pricing against the broader market, remember that Medicare's benchmark rate for this service is $10.56; comparing your negotiated or cash rates to this federal baseline rather than the hospital's gross charge provides a clearer picture of the true cost and any potential markup.