Blood test, comprehensive metabolic panel
Facility: Scott County Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $74
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 7.01x 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 701% of the Medicare baseline (a markup of 601%). 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 |
|---|---|---|
| UnitedHealthcare | $11 - $78 | 104% |
| Blue Cross Blue Shield | $23 | 218% |
| Humana | $34 | 322% |
| Wppa | $49 - $1,200 | 464% |
| Aetna | $74 | 701% |
Consumer Guidance & Cost Commentary
For the comprehensive metabolic panel (CPT 80053) at Scott County Hospital in Scott City, KS, the facility's negotiated rates range from $11 to $1200 across five insurance plans, with a median negotiated amount of $74. This commercial rate is significantly higher than the Medicare benchmark of $10.56, reflecting the standard administrative markup inherent in insurance contracts. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that cash-pay options are often more cost-effective than insurance claims, particularly for those with high-deductible plans where the insurer's allowed amount may exceed the cash price. The data indicates no specific cash or median paid values were reported for this service, so it is crucial to contact the hospital directly to confirm current self-pay or prompt-pay discounts before scheduling.
Patients should exercise caution regarding balance billing and billing errors, as these services can sometimes be billed at the full chargemaster rate if out-of-network components are involved, even at an in-network facility. Although the No Surprises Act protects against balance billing for emergency and non-emergency services at in-network hospitals, verifying that all ancillary services are covered under the same network tier is essential. Furthermore, since over 80% of hospital bills contain errors, patients should never accept a summary bill as final; instead, they should request a detailed, itemized statement to identify any unbundled codes or services not rendered. By comparing the facility's rates directly to the Medicare benchmark rather than the inflated chargemaster list, consumers can better understand the true cost of care and negotiate more effectively with the billing department.