Blood test, comprehensive metabolic panel
Facility: Hamilton County Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $135
- Cash Discount Price: $150
- vs. Medicare Baseline: 12.78x 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 1278% of the Medicare baseline (a markup of 1178%). 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 - $23 | 104% |
| First Health Coventry - All Plans | $128 | 1212% |
| UnitedHealthcare | $142 | 1345% |
| Cigna | $142 | 1345% |
| Va Ccn - All Plans | $150 | 1420% |
| Aetna | $255 | 2415% |
Consumer Guidance & Cost Commentary
For this comprehensive metabolic panel at Hamilton County Hospital in Syracuse, KS, the cash price of $150 is significantly lower than the negotiated rates charged by major insurers like Aetna ($255) and UnitedHealthcare ($142). While the facility's cash rate matches the gross charge, patients with high-deductible plans may find paying $150 upfront more cost-effective than relying on insurance, which could result in a higher out-of-pocket expense if the deductible is not yet met. It is important to note that commercial negotiated rates often include administrative overhead and do not reflect the true cost of care, making the cash price a more transparent benchmark for comparison.
The facility's cash rate of $150 is notably higher than the state average for this service, which is approximately $10.56 based on Medicare benchmarks. Although Medicare rates represent a lower baseline, they are calculated using specific federal cost reports rather than commercial market dynamics. To potentially reduce costs further, patients should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can range from 20% to 50% off the billed amount for upfront payment. Additionally, if you have received a bill from this facility, you should request a full itemized statement to ensure no errors or unbundled charges exist before finalizing payment.