Blood test, comprehensive metabolic panel
Facility: Wamego Health Center
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $11
- Cash Discount Price: $89
- vs. Medicare Baseline: 1.04x 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.
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 |
|---|---|---|
| Aetna | $11 | 104% |
| Providrs Care | $11 | 104% |
| Medicaid / KanCare | $11 | 104% |
| UnitedHealthcare | $11 | 104% |
| Blue Cross Blue Shield | $189 - $200 | 1790% |
Consumer Guidance & Cost Commentary
For the comprehensive metabolic panel (CPT 80053) at Wamego Health Center, the cash price of $89.00 is significantly lower than the facility's negotiated rates, which range from $11.00 to $200.00 depending on the insurance plan. While the cash price is the lowest amount listed, it is important to note that for patients with high-deductible plans, paying cash upfront can sometimes be cheaper than the insurance negotiated rate if the insurer's allowed amount exceeds the cash price. However, since the data shows a median negotiated rate of $11.00, many insured patients may find their insurance payment lower than the cash option, though this depends on their specific plan's deductible and coinsurance.
This service is provided by a Critical Access Hospital in Wamego, Kansas, and the facility's cash rate of $89.00 is notably higher than the state and county average for this procedure. The Medicare benchmark for this code is $10.56, which serves as a baseline for evaluating pricing fairness; commercial negotiated rates often exceed this by a significant margin due to administrative costs and contract dynamics. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but it is crucial to verify network status and request a self-pay or prompt-pay discount before scheduling to avoid unexpected bills. Always ask the billing department for an itemized statement to ensure all charges are accurate and to identify any potential errors before payment.