Blood test, comprehensive metabolic panel
Facility: Phillips County Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $84
- Cash Discount Price: $79
- vs. Medicare Baseline: 7.95x 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 795% of the Medicare baseline (a markup of 695%). 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 | $23 - $75 | 218% |
| UnitedHealthcare | $74 - $93 | 701% |
| Health Partners-All Plans | $93 | 881% |
| Medicaid / KanCare | $93 | 881% |
Consumer Guidance & Cost Commentary
For the comprehensive metabolic panel (CPT 80053) at Phillips County Hospital in Phillipsburg, Kansas, the negotiated rates range from $23 to $93 depending on your specific insurance plan, with Blue Cross Blue Shield offering the lowest tier at $23 and UnitedHealthcare at $74. These commercial rates are significantly higher than the facility's cash price of $79 and the state average of $72, though they remain below the gross chargemaster of $93. Because commercial insurance contracts often include administrative overhead that inflates the baseline price by 20% to 40%, patients with high-deductible plans may find paying the cash price of $79 directly more cost-effective than relying on insurance, which could result in a negotiated rate exceeding the cash amount.
To minimize out-of-pocket costs, it is essential to verify if your specific plan falls within the lowest negotiated tier or to inquire about self-pay and prompt-pay discounts before scheduling your visit, as these upfront payment incentives can bypass costly claims processing fees. Additionally, while the facility is a Critical Access Hospital owned by the local government, the Medicare benchmark for this service is $10.56, highlighting that commercial rates are substantially marked up above the federal cost baseline. If you receive a bill that appears to include balance billing for out-of-network ancillary services, remember that the No Surprises Act protects you from such charges for non-emergency care at in-network facilities, and you should request a full itemized audit to identify any unbundled codes or services not rendered.