Blood test, comprehensive metabolic panel
Facility: Nemaha Valley Community Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $17
- Cash Discount Price: $33
- vs. Medicare Baseline: 1.61x 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.
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 |
|---|---|---|
| Va Ccn - All Plans | $2 - $6 | 19% |
| Humana | $8 - $25 | 76% |
| Aetna | $8 - $48 | 76% |
| Celtic Comm Exch - All Plans | $9 - $27 | 85% |
| Partners Direct Health - All Plans | $9 - $29 | 85% |
| Multiplan - All Plans | $16 - $50 | 152% |
| Health Partners - All Plans | $17 - $53 | 161% |
| Midlands Choice - All Plans | $17 - $53 | 161% |
Consumer Guidance & Cost Commentary
For Nemaha Valley Community Hospital in Seneca, Kansas, the comprehensive metabolic panel (CPT 80053) has a cash median price of $33.00, which is notably lower than the facility's negotiated rates paid by major insurers like Aetna ($8–$48) and Multiplan ($16–$50). While the facility's cash price is higher than its own negotiated average of $17.00, it remains significantly below the gross chargemaster of $37.00. For patients with high-deductible plans, paying the cash price of $33.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. Additionally, patients should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill before any insurance claim is processed.
When evaluating this price against broader benchmarks, the facility's cash rate is higher than the Medicare amount of $10.56, reflecting a markup typical of commercial pricing structures where negotiated rates often range between 200% and 300% of Medicare. However, the facility's negotiated rate of $17.00 sits well below the gross charge, demonstrating the value of in-network contracts. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still request an itemized bill to verify that all charges are accurate and that no unbundled codes or services not rendered have been included. Disputing any errors in writing is the most effective way to ensure the final invoice reflects the