Blood test, comprehensive metabolic panel
Facility: Greenwood County Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $230
- Cash Discount Price: $218
- vs. Medicare Baseline: 21.78x 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 2178% of the Medicare baseline (a markup of 2078%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $21 - $22 | 199% |
| UnitedHealthcare | $29 - $228 | 275% |
| Triwest - All Plans | $97 | 919% |
| Choicecare Mcr Adv - All Plans | $114 | 1080% |
| Tricare | $114 | 1080% |
| Integrated Health Plan - All Plans | $204 | 1932% |
| First Health Ccn Network | $231 | 2188% |
| First Health - All Other Plans | $231 | 2188% |
| Beech Street - All Plans | $231 | 2188% |
| Preferred Hs (Coventry) - All Plans | $245 | 2320% |
| Principal Health Care Inc - All Plans | $258 | 2443% |
| Medicaid / KanCare | $272 | 2576% |
| Amerigroup Mcaid-All Plans | $272 | 2576% |
| Providrs Care/Wppa - All Plans | $408 | 3864% |
Consumer Guidance & Cost Commentary
For this comprehensive metabolic panel at Greenwood County Hospital in Eureka, Kansas, the cash price is $218.00, which is lower than the facility's negotiated rates for most major payers. While the median negotiated amount across all plans is $230.00, specific commercial insurers like UnitedHealthcare and Triwest have significantly higher contracted rates of $228.00 and $97.00 respectively. Because cash prices often fall below insurance negotiated rates, patients with high-deductible plans may save money by paying the cash price directly, provided they verify the facility's "self-pay" or "prompt-pay" discounts before scheduling. It is important to note that while the cash rate is competitive, the facility's gross charge of $272.00 represents the full list price before any discounts are applied.
When evaluating the cost of this service, it is essential to compare rates against federal benchmarks rather than the hospital's inflated chargemaster. The Medicare amount for this procedure is $10.56, and the facility's cash rate of $218.00 is approximately 21.8 times the Medicare benchmark. This significant markup is typical for commercial pricing structures, where negotiated rates often range from 200% to 300% of the Medicare rate due to administrative costs and contract dynamics. Consumers should be aware that summary bills may obscure these details, so requesting a full itemized statement is crucial for identifying any unbundled codes or services not rendered. If a balance bill arises from an out-of-network ancillary service, patients should dispute the charge with their insurer rather than paying immediately, as federal protections may apply.