Blood test, comprehensive metabolic panel
Facility: Great Plains Of Sabetha
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $62
- Cash Discount Price: $65
- vs. Medicare Baseline: 5.87x 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 587% of the Medicare baseline (a markup of 487%). 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 |
|---|---|---|
| Celtic Mcr Adv | $34 | 322% |
| Aetna | $34 - $66 | 322% |
| Celtic Comm Exchange-All Other Plans | $42 | 398% |
| Great West Healthcare-All Plans | $55 | 521% |
| UnitedHealthcare | $60 - $65 | 568% |
| Multiplan-Phcs-All Plans | $62 | 587% |
| Humana | $62 | 587% |
| Cigna | $62 | 587% |
| Century/Wppa/Providers-All Plans | $62 | 587% |
| Federated Mutual Ins-All Plans | $62 | 587% |
| Blue Cross Blue Shield | $65 | 616% |
| Medicaid / KanCare | $65 | 616% |
Consumer Guidance & Cost Commentary
For the comprehensive metabolic panel (CPT 80053) at Great Plains Of Sabetha in Sabetha, Kansas, the cash price is $65.00, which matches the facility's gross charge and the median cash rate reported for this code. This cash price is notably higher than the state average of $59.00 for the same service. While commercial insurance plans like Aetna and UnitedHealthcare negotiate rates ranging from $34 to $65, these negotiated amounts often exceed the cash price. Patients with high-deductible plans may find it financially advantageous to pay the $65.00 cash rate directly, as this avoids the administrative overhead and potential higher negotiated fees charged by insurers. To secure the best possible rate, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as hospitals often offer significant reductions for upfront payment that are not automatically applied to insurance claims.
The facility's negotiated rates vary significantly by payer, with the lowest allowed amount being $34.00 from Celtic Mcr Adv and the highest being $65.00 from Blue Cross Blue Shield and Medicaid/KanCare. It is important to note that Medicare reimburses for this service at $10.56, which serves as a benchmark for the true cost of care; commercial rates are substantially higher than this federal baseline. Additionally, the facility is a Critical Access Hospital in a voluntary non-profit setting, which may influence its pricing structure compared to larger urban centers. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it is crucial to verify network status and request an item