Blood test, comprehensive metabolic panel
Facility: Decatur Health
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $34
- Cash Discount Price: $40
- vs. Medicare Baseline: 3.22x 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 322% of the Medicare baseline (a markup of 222%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $26 | 246% |
| Humana | $27 | 256% |
| UnitedHealthcare | $27 - $34 | 256% |
| Blue Cross Blue Shield | $29 | 275% |
| Midlands Choice- All Plans | $40 | 379% |
| Aetna | $40 - $44 | 379% |
| Medicaid / KanCare | $45 | 426% |
Consumer Guidance & Cost Commentary
For this comprehensive metabolic panel at Decatur Health in Oberlin, KS, the cash median price is $40.00, which is slightly lower than the facility's gross charge of $44.00. 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 has a negotiated range of $27 to $34, and Aetna ranges from $40 to $44, meaning patients with high-deductible plans might save money by paying the $40.00 cash rate directly, provided they secure a prompt-pay discount before the claim is submitted. It is crucial to ask the billing office specifically about self-pay or prompt-pay discounts prior to scheduling to avoid being billed the higher insurance negotiated amounts.
When evaluating the cost of this service, it is important to compare rates against federal benchmarks rather than the facility's full list price. The Medicare amount for this code is $10.56, and the facility's negotiated rates generally fall between 300% and 400% of this federal baseline, which is significantly higher than the typical fair pricing range of 120% to 150% of Medicare. Additionally, the median paid amount across payers is $32.00, while the median negotiated rate is $34.00. If a patient receives care from an out-of-network provider or encounters unexpected ancillary services, they may face balance billing for the difference between the allowed amount and the full charge, though the No Surprises Act offers protections for emergency and non-em