Blood test, comprehensive metabolic panel
Facility: Hospital District #6 Patterson Health Center
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $110
- Cash Discount Price: $98
- vs. Medicare Baseline: 10.42x 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 1042% of the Medicare baseline (a markup of 942%). 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 | $110 - $122 | 1042% |
| Providers Care (Wppa)-All Plans | $214 | 2027% |
Consumer Guidance & Cost Commentary
For the comprehensive metabolic panel (CPT 80053) at the Hospital District #6 Patterson Health Center in Anthony, KS, the cash price of $98.00 is notably lower than the facility's negotiated rate of $110.00 and the Medicare benchmark of $10.56. While the facility is a Critical Access Hospital with government ownership, patients should be aware that commercial insurance plans like UnitedHealthcare and Blue Cross Blue Shield have negotiated rates ranging from $110 to $222, which often exceed the cash price. This pricing structure highlights a common scenario where paying out-of-pocket can be more cost-effective than using insurance, particularly for those with high-deductible plans who may not yet have met their coverage thresholds. To maximize savings, patients are encouraged to explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill by bypassing administrative processing fees and insurance claim cycles.
When evaluating this service, it is critical to compare rates against the Medicare benchmark rather than the hospital's inflated chargemaster list, as commercial negotiated rates frequently average 200% to 300% of the Medicare rate. Although the data provided does not include specific state or county average figures for this procedure, the Medicare amount of $10.56 serves as the scientifically validated baseline for determining fair pricing in this region. Patients should avoid relying on summary bills that obscure individual line items, as over 80% of hospital charges contain errors such as unbundled codes or services not rendered. If a balance bill or unexpected charge arises, consumers should request a formal itemized audit and utilize the No