Blood test, comprehensive metabolic panel
Facility: Rooks County Health Center
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $43
- Cash Discount Price: $35
- vs. Medicare Baseline: 4.07x 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 407% of the Medicare baseline (a markup of 307%). 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 |
|---|---|---|
| Veterans Admin - All Plans | $5 | 47% |
| Celtic Mcr Adv | $22 | 208% |
| Tricare | $22 | 208% |
| Blue Cross Blue Shield | $23 | 218% |
| Celtic Comm - All Other Plans | $24 | 227% |
| Preferred Benefits Admin | $43 | 407% |
| Aetna | $43 | 407% |
| UnitedHealthcare | $43 | 407% |
| Preferred Hlthcare - All Other Plans | $45 | 426% |
| Health Partners - All Plans | $45 | 426% |
| Healthy Blue Mcaid - All Plans | $47 | 445% |
Consumer Guidance & Cost Commentary
For the CPT code 80053, representing a comprehensive metabolic panel at Rooks County Health Center in Plainville, Kansas, the facility's cash median price is $35.00, which is lower than the state average of $47.00. While the facility's negotiated rates with commercial payers range from $22.00 to $47.00, patients should be aware that cash payments can sometimes be more cost-effective than insurance claims, particularly if the insurance negotiated rate exceeds the cash price. Given that the facility is a Critical Access Hospital owned by a Government Hospital District, it is advisable to contact the billing department directly to confirm if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront incentives can bypass administrative fees and reduce the final amount owed.
When reviewing your bill, it is crucial to request an itemized statement rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. For this specific test, the Medicare benchmark amount is $10.56, which serves as a scientifically validated baseline for the true cost of care; commercial negotiated rates often average 200% to 300% of this figure, though fair pricing is typically defined as 120% to 150% of the Medicare rate. If you receive a bill that appears inflated, you should dispute any errors in writing to the billing supervisor rather than settling verbally, ensuring that charges for medications or supplies that were cancelled are removed before payment.