Blood test, comprehensive metabolic panel
Facility: Hiawatha Community Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $82
- Cash Discount Price: $105
- vs. Medicare Baseline: 7.77x 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 777% of the Medicare baseline (a markup of 677%). 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 | $22 - $23 | 208% |
| UnitedHealthcare | $39 - $90 | 369% |
| Humana | $39 | 369% |
| Aetna | $39 - $85 | 369% |
| Ambetter / Centene | $47 | 445% |
| Centrus Health Direct - All Plans | $79 | 748% |
| Oscar - All Plans | $79 | 748% |
| Preferred Hlth - All Plans | $94 | 890% |
| Wppa Providrs Care - All Plans | $100 | 947% |
| Cigna | $100 | 947% |
| Midlands Choice - All Plans | $102 | 966% |
| Multiplan - All Plans | $102 | 966% |
| Healthy Blue Mcaid - All Plans | $105 | 994% |
Consumer Guidance & Cost Commentary
For the CPT code 80053 (Blood test, comprehensive metabolic panel) at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $105.00, which matches the facility's gross charge and is significantly higher than the state average of $79.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. For instance, UnitedHealthcare and Aetna have negotiated ranges starting at $39 but extending up to $90, whereas the cash price remains flat at $105.00. This suggests that for patients with high-deductible plans or those who have already met their out-of-pocket maximum, paying the cash price directly could result in lower total costs compared to the insurance negotiated rates.
To ensure you are receiving the most accurate pricing, it is recommended to request an itemized billing audit before finalizing payment, as summary bills may obscure individual code costs or include unbundled charges. Additionally, you should inquire about prompt-pay discounts, which can reduce the cash price by 20% to 50% if paid upfront, effectively bypassing the administrative costs associated with insurance claims processing. When comparing this service to the national benchmark, the Medicare amount for this procedure is $10.56, indicating that the cash price represents a substantial markup relative to the federal cost basis. Always verify your specific plan's deductible status and allowed amounts with the hospital prior to scheduling to avoid unexpected balance billing or overpayment.