Blood test, comprehensive metabolic panel
Facility: Ellsworth County Medical Center
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $35
- Cash Discount Price: $90
- vs. Medicare Baseline: 3.31x 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 331% of the Medicare baseline (a markup of 231%). 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 |
|---|---|---|
| Healthy Blue Mcr Adv | $13 - $71 | 123% |
| Va Ccn-All Plans | $13 - $71 | 123% |
| Humana | $13 - $144 | 123% |
| Triwest -All Plans | $13 - $71 | 123% |
| UnitedHealthcare | $18 - $152 | 170% |
| Blue Cross Blue Shield | $21 - $22 | 199% |
| Aetna | $25 - $137 | 237% |
| First Health - All Plans | $25 - $137 | 237% |
| Cigna | $27 - $144 | 256% |
| Medicaid / KanCare | $28 - $152 | 265% |
| Healthy Blue Mcaid- All Other Plans | $28 - $152 | 265% |
| Coventry Mcaid-All Plans | $28 - $152 | 265% |
| Providers Care-Wppa-All Plans | $42 - $228 | 398% |
Consumer Guidance & Cost Commentary
For the comprehensive metabolic panel (CPT 80053) at Ellsworth County Medical Center in Ellsworth, KS, the cash price is $90.00, which matches the facility's median negotiated rate. This cash price is significantly lower than the state average for this service, where patients typically pay between $21.00 and $228.00 depending on their specific insurance plan. While commercial payers like UnitedHealthcare and Humana negotiate rates ranging from $18.00 to $152.00, the cash price remains the most transparent benchmark for patients without insurance. Because commercial negotiated rates often include administrative overhead and vary by payer, paying cash upfront can sometimes result in a lower total cost than what an insurance plan would allow, particularly if the patient has a high deductible or is self-pay.
Patients should verify if their specific insurance plan falls within the facility's network, as out-of-network care could trigger balance billing for the difference between the provider's full charge and the insurer's allowed amount. Although the No Surprises Act protects emergency care and non-emergency services at in-network facilities from such surprise bills, it is crucial to request an itemized bill to ensure no unbundled codes or services not rendered are included. Additionally, patients should inquire about prompt-pay discounts, which can reduce the $90.00 cash price by 20% to 50% if paid in full within a short window, bypassing the administrative costs associated with insurance claims processing. Always compare the final allowed amount to the Medicare benchmark of $10.56 to understand the true cost basis, as commercial rates often exceed this baseline due to contract dynamics and