Blood test, comprehensive metabolic panel
Facility: Graham County Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $28
- Cash Discount Price: $46
- vs. Medicare Baseline: 2.65x 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 265% of the Medicare baseline (a markup of 165%). 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 |
|---|---|---|
| UnitedHealthcare | $5 - $44 | 47% |
| Medicaid / KanCare | $17 | 161% |
| Blue Cross Blue Shield | $22 | 208% |
| Medicare (plans) | $34 | 322% |
| Celtic Commercial-All Other Plans | $38 | 360% |
| Wppa (Providers Care)-All Plans | $44 | 417% |
Consumer Guidance & Cost Commentary
For this comprehensive metabolic panel test at Graham County Hospital in Hill City, Kansas, the cash price is $46.00, which matches the facility's median negotiated rate. While the facility is a Critical Access Hospital owned by the local government, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. In this specific case, the median negotiated rate of $38.00 is lower than the cash price, meaning using insurance may result in a lower out-of-pocket cost if the patient's deductible has been met. However, if a patient has a high-deductible plan where the deductible has not yet been satisfied, paying the full cash price of $46.00 upfront could be more cost-effective than facing the full negotiated rate plus any potential deductibles.
The facility's pricing is benchmarked against the Medicare rate of $10.56, which serves as a federal baseline for the true cost of care. The cash price of $46.00 represents a significant markup relative to this baseline, a common dynamic in commercial billing where rates can average 200% to 300% of Medicare amounts. To maximize savings, patients should verify their specific plan's allowed amount before scheduling, as in-network rates vary significantly by carrier. Additionally, since the facility is a government-owned Critical Access Hospital, patients should explicitly ask about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% if paid in full before or shortly after the service.