Blood test, comprehensive metabolic panel
Facility: Sheridan County Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $31
- Cash Discount Price: $46
- vs. Medicare Baseline: 2.94x 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 294% of the Medicare baseline (a markup of 194%). 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 Insurance | $28 | 265% |
| Blue Cross Blue Shield | $31 | 294% |
| UnitedHealthcare | $44 | 417% |
Consumer Guidance & Cost Commentary
For the comprehensive metabolic panel (CPT 80053) at Sheridan County Hospital in Hoxie, KS, the cash price is $46.00, which matches the facility's median negotiated rate of $31.00 and the cash median. This service is benchmarked against Medicare at 2.9 times the federal rate, reflecting the standard markup seen in commercial pricing where negotiated rates often average 200% to 300% of Medicare costs. While the facility is a government-owned Critical Access Hospital, patients with high-deductible plans may find paying the full cash price of $46.00 more cost-effective than using insurance, as the negotiated rate of $31.00 could still exceed the patient's out-of-pocket responsibility if their deductible has not been met.
To minimize costs, patients should verify their specific insurance plan's allowed amount before scheduling, as in-network contracts vary significantly even within the same county. If you choose to pay directly, ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% for upfront payment and bypass administrative fees associated with insurance claims. Additionally, ensure you receive a detailed, itemized bill rather than a summary statement, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be corrected through a formal written audit dispute.