Blood test, comprehensive metabolic panel
Facility: St Luke Hospital & Living Center
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $73
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 6.91x 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 691% of the Medicare baseline (a markup of 591%). 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 |
|---|---|---|
| Humana | $73 | 691% |
| UnitedHealthcare | $73 | 691% |
| Va Ccn | $73 | 691% |
| Bluestem Pace | $73 | 691% |
| Blue Cross Blue Shield | $73 | 691% |
| Kansas Department Of Health And Environment | $73 | 691% |
| Ambetter / Centene | $74 | 701% |
Consumer Guidance & Cost Commentary
For the CPT code 80053, representing a comprehensive metabolic panel blood test, the facility's negotiated rate is $73.00, which aligns with the lowest and highest negotiated amounts reported for this service across all payers. This rate is significantly lower than the facility's gross charge of $144.00, reflecting the contractual ceilings set by insurance carriers. When compared to the Medicare benchmark of $10.56, the negotiated rate represents a 6.9x markup, illustrating the substantial difference between federal cost-based reimbursement and commercial pricing structures.
While the facility is a Critical Access Hospital in Marion, KS, and is owned by a Government Hospital District, patients should be aware that cash-pay options are not explicitly listed in the available data. However, it is important to note that cash prices can sometimes be lower than insurance negotiated rates for those with high-deductible plans, provided the patient pays upfront and secures a prompt-pay discount before the claim is submitted. To avoid unexpected balance billing or administrative fees, patients are encouraged to contact the billing department directly to confirm self-pay rates and request a waiver of insurance submission prior to scheduling their visit.