Blood test, comprehensive metabolic panel
Facility: Clay County Medical Center
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $95
- Cash Discount Price: $100
- vs. Medicare Baseline: 9.00x 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 900% of the Medicare baseline (a markup of 800%). 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 |
|---|---|---|
| Aetna | $93 | 881% |
| Wppa/Providrs Care- All Plans | $93 | 881% |
| UnitedHealthcare | $95 | 900% |
| Multiplan- All Plans | $95 | 900% |
| Health Partners - All Plans | $95 | 900% |
Consumer Guidance & Cost Commentary
For this comprehensive metabolic panel at Clay County Medical Center in Clay Center, KS, the cash price is $100.00, which is identical to the facility's negotiated rate of $95.00 and the median paid by insurers like Aetna and UnitedHealthcare. While the facility is a Critical Access Hospital with a government-local ownership structure, the cash price remains the most transparent benchmark for patients. It is important to note that cash payments can sometimes be cheaper than insurance reimbursement; in this case, the cash rate matches the negotiated amount, meaning there is no financial advantage to paying out-of-pocket for this specific service. However, patients should always verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront incentives can reduce the final cost by bypassing administrative fees and claims processing delays.
When evaluating this price against broader benchmarks, the facility's cash rate of $100.00 is significantly higher than the Medicare amount of $10.56, reflecting the standard markup found in commercial healthcare. Although the data indicates a 9% variance versus Medicare, the primary takeaway for consumers is that the negotiated rate of $95.00 serves as a reliable ceiling for in-network coverage. If you have a high-deductible plan, you might find it beneficial to pay the cash price directly if your insurance allowed amount exceeds this figure, though here the rates are aligned. To ensure you are not overcharged, always request an itemized bill that lists specific CPT codes rather than accepting a summary invoice, and dispute any unexpected charges in writing to avoid balance billing surprises, even though the No Surprises Act protects many emergency and non-emergency services at in-network