Blood test, comprehensive metabolic panel
Facility: Trego County Lemke Memorial Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $31
- Cash Discount Price: $31
- 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 |
|---|---|---|
| Va Ccn - All Plans | $4 | 38% |
| Humana | $18 | 170% |
| Tricare | $19 | 180% |
| UnitedHealthcare | $22 - $36 | 208% |
| Aetna | $22 - $32 | 208% |
| Medicaid / KanCare | $22 - $36 | 208% |
| Ambetter / Centene | $25 | 237% |
| Blue Cross Blue Shield | $31 | 294% |
| Health Partners - All Plans | $34 | 322% |
| Healthy Blue Mcaid - All Plans | $36 | 341% |
Consumer Guidance & Cost Commentary
For the comprehensive metabolic panel (CPT 80053) at Trego County Lemke Memorial Hospital, the cash price of $31.00 is notably lower than the facility's negotiated rates, which range from $22.00 to $36.00 depending on the payer. While the median negotiated amount paid by insurers is $22.00, patients with high-deductible plans may find paying the cash price of $31.00 more cost-effective if their insurance allowed amount exceeds this figure, as the administrative overhead of processing claims often inflates the final bill. It is important to note that while the facility is in-network for most payers, the No Surprises Act protects patients from balance billing for out-of-network services at this Critical Access Hospital, though patients should still verify their specific plan's allowed amount before scheduling to ensure they are not facing unexpected costs.
The facility's pricing is benchmarked against federal standards, with the Medicare rate for this service set at $10.56. The cash price of $31.00 represents a significant markup over the Medicare baseline, which serves as the objective cost measure for healthcare delivery. Commercial negotiated rates typically average between 200% and 300% of Medicare, reflecting the administrative costs and contract dynamics inherent in insurance billing. To maximize savings, patients should request a prompt-pay discount, which can reduce the bill by 20% to 50% if paid in full upfront, and must explicitly waive insurance submission to avoid automatic claims processing that voids these discounts. Additionally, patients should demand a full itemized bill to identify any unbundled codes or services not rendered, as