Blood test, comprehensive metabolic panel
Facility: Girard Medical Center
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $81
- Cash Discount Price: $138
- vs. Medicare Baseline: 7.67x 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 767% of the Medicare baseline (a markup of 667%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $23 - $80 | 218% |
| Aetna | $80 - $402 | 758% |
| Ambetter / Centene | $80 | 758% |
| Medicare (plans) | $80 | 758% |
| Humana | $80 | 758% |
| Kansas Superior Select-All Plans | $80 | 758% |
| UnitedHealthcare | $80 - $218 | 758% |
| Multiplan-All Plans | $213 | 2017% |
| Uhhis-All Plans | $218 | 2064% |
Consumer Guidance & Cost Commentary
For a comprehensive metabolic panel at Girard Medical Center, the cash price of $138.00 is notably lower than the facility's negotiated rates, which range from $80.00 to $402.00 across nine different insurance plans. While several payers, including Aetna and UnitedHealthcare, have negotiated rates exceeding the cash price, patients with high-deductible plans may find paying out-of-pocket initially more cost-effective. It is important to note that the facility's cash rate is significantly higher than the Medicare benchmark of $10.56, reflecting the typical administrative markup associated with commercial billing cycles. To maximize savings, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing costly insurance claims processing.
The facility's negotiated rates also exceed the state average for this service, though specific county-level averages were not provided in the available data. Under the No Surprises Act, patients are protected from balance billing for out-of-network services at in-network facilities, but they should still verify their specific plan details to ensure they are not subject to unexpected charges. If a patient receives an itemized bill, they should request a full line-by-line audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected. By comparing the facility's rates directly to the Medicare benchmark and actively seeking prompt-pay discounts, consumers can better understand the true cost of care and avoid unnecessary debt.