Blood test, comprehensive metabolic panel
Facility: Fredonia Regional Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $70
- Cash Discount Price: $78
- vs. Medicare Baseline: 6.63x 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 663% of the Medicare baseline (a markup of 563%). 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 | $8 - $70 | 76% |
| Blue Cross Blue Shield | $23 - $39 | 218% |
| Veterans Programs - All Plans | $40 | 379% |
| Aetna | $40 - $70 | 379% |
| Reserve National-All Plans | $70 | 663% |
| Cigna | $70 | 663% |
| Meritain-All Plans | $70 | 663% |
Consumer Guidance & Cost Commentary
For the comprehensive metabolic panel (CPT 80053) at Fredonia Regional Hospital in Kansas, the cash price is $78.00, which matches the facility's median negotiated rate of $70.00 and the cash median. This cash price is significantly higher than the Medicare benchmark of $10.56, reflecting a markup common in commercial billing. While the facility is a Critical Access Hospital with government local ownership, patients should be aware that cash payments can sometimes be more cost-effective than using insurance if their plan's negotiated rate exceeds the cash price. Given that the facility's cash rate is well above the Medicare baseline, patients with high-deductible plans may find paying out-of-pocket directly to the hospital avoids the administrative overhead and potential higher negotiated rates charged by insurance carriers.
To minimize costs, patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling their visit, as these upfront payment incentives can reduce the bill by 20% to 50%. It is crucial to avoid automatic claims submission, which can void cash agreements, and instead sign a waiver of insurance submission to secure the lower cash rate. Additionally, since over 80% of hospital bills contain errors, patients should demand a full itemized CPT-coded statement rather than accepting a summary bill, ensuring they can identify any unbundled codes or services not rendered. While specific county or state average comparisons were not provided in the data, understanding that the facility's rates are benchmarked against the federal Medicare rate helps clarify the true cost structure of this service.