Blood test, comprehensive metabolic panel
Facility: Ashland Health Center
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $33
- Cash Discount Price: $26
- vs. Medicare Baseline: 3.13x 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 313% of the Medicare baseline (a markup of 213%). 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 | $11 | 104% |
| Compalliance-All Plans | $26 | 246% |
| Health Partners Of Kansas-All Plans | $28 | 265% |
| Multiplan-All Plans | $32 | 303% |
| Healthy Blue Mcr Adv - All Other Plans | $33 | 313% |
| Aetna | $33 | 313% |
| Medicaid / KanCare | $33 | 313% |
| Medicare (plans) | $33 | 313% |
| UnitedHealthcare | $33 | 313% |
| Medica Mcare - All Plans | $33 | 313% |
| Health Choice-All Plans | $33 | 313% |
| Providers Care (Wppa)-All Plans | $50 | 473% |
Consumer Guidance & Cost Commentary
For the comprehensive metabolic panel (CPT 80053) at Ashland Health Center in Ashland, KS, the facility's negotiated rates range from $11 to $50 across 12 insurance plans, with a median negotiated amount of $33.00. This commercial rate is notably higher than the Medicare benchmark of $10.56, reflecting the administrative costs and contract structures inherent in insurance billing. While the facility's cash price of $26.00 is lower than the median negotiated rate of $33.00, patients with high-deductible plans may find paying cash upfront more cost-effective than relying on insurance, which often processes claims at rates exceeding the cash price. It is important to note that while the facility is a Critical Access Hospital in a Voluntary non-profit structure, specific self-pay or prompt-pay discounts should be confirmed directly with the billing department before scheduling services to ensure the lowest possible out-of-pocket cost.
The pricing data for this service does not include a specific county or state average for comparison in the provided dataset, so the facility's rates are evaluated primarily against the federal Medicare benchmark. Under the No Surprises Act, patients should be aware that balance billing for out-of-network services at this in-network facility is generally prohibited for emergency care and non-emergency services. If a patient receives an itemized bill that appears higher than the negotiated or cash rates, they should request a formal, written itemized audit to identify potential errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain discrepancies. Consumers are advised to avoid paying surprise bills immediately and instead dispute them with the insurer or request a No Surprises Act