Blood test, comprehensive metabolic panel
Facility: Medicine Lodge Memorial Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $58
- Cash Discount Price: $62
- vs. Medicare Baseline: 5.49x 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 549% of the Medicare baseline (a markup of 449%). 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 |
|---|---|---|
| Tricare | $49 | 464% |
| Humana | $56 | 530% |
| Aetna | $57 - $62 | 540% |
| UnitedHealthcare | $58 | 549% |
| Hpk-All Plans | $58 | 549% |
| Medicaid / KanCare | $62 | 587% |
Consumer Guidance & Cost Commentary
For the comprehensive metabolic panel (CPT 80053) at Medicine Lodge Memorial Hospital in Medicine Lodge, Kansas, the cash price is $62.00, which matches the facility's gross charge. This rate is significantly higher than the state average, as indicated by a 5.5% variance versus the state benchmark. While commercial payers like Aetna and UnitedHealthcare have negotiated rates ranging from $56 to $62, the cash price remains the lowest option for self-pay patients. If you have a high-deductible plan where your deductible has not yet been met, paying the cash price of $62.00 upfront may be more cost-effective than relying on insurance, which could result in a negotiated rate exceeding the cash amount.
To ensure you are receiving the most accurate pricing, always request an itemized bill before finalizing payment, as summary bills can obscure individual line items and potential errors. Additionally, inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the total cost if you settle the bill in full within a short window. Since this facility is a Critical Access Hospital owned by a Government Hospital District, verify that your specific insurance plan is in-network to avoid unexpected balance billing, though the No Surprises Act generally protects you from being billed for out-of-network services at in-network facilities.