Blood test, comprehensive metabolic panel
Facility: Holton Community Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $65
- Cash Discount Price: $72
- vs. Medicare Baseline: 6.16x 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 616% of the Medicare baseline (a markup of 516%). 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 | $22 | 208% |
| Aetna | $35 - $127 | 331% |
| Kansas Superior Select - All Plans | $35 - $69 | 331% |
| UnitedHealthcare | $35 - $127 | 331% |
| Humana | $35 - $68 | 331% |
| Preferred Health Professionals | $54 - $105 | 511% |
| Preferred Health Freedom | $54 - $105 | 511% |
| Preferred Health Fn Select - All Other Plans | $54 - $105 | 511% |
| Wppa Providers - All Plans | $62 - $121 | 587% |
| Medicaid / KanCare | $65 - $127 | 616% |
Consumer Guidance & Cost Commentary
For the comprehensive metabolic panel (CPT 80053) at Holton Community Hospital, the cash price of $72.00 is significantly lower than the negotiated rates paid by insurance plans, which range from $35.00 to $127.00 depending on the carrier. While the facility's cash rate is higher than the state average of $66.00, it remains well below the gross charges listed on the hospital's price list. Patients with high-deductible plans or those who have not yet met their out-of-pocket maximums may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. To secure the lowest possible price, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling the test, as these upfront payment incentives can reduce the final bill by 20% to 50%.
When evaluating the cost of this blood test, it is important to compare rates against the Medicare benchmark rather than the hospital's inflated chargemaster list. The Medicare amount for this procedure is $10.56, and the facility's cash rate represents a markup of approximately 6.2 times the Medicare rate, which aligns with fair pricing standards typically defined as 120% to 150% of Medicare. Commercial negotiated rates, which average 200% to 300% of Medicare, are often higher than cash prices due to administrative overhead and contract dynamics. If a patient receives an itemized bill that includes unexpected charges for services not rendered or unbundled components, they should request a formal written audit dispute to ensure the final invoice