Blood test, comprehensive metabolic panel
Facility: Smith County Memorial Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $40
- Cash Discount Price: $43
- vs. Medicare Baseline: 3.79x 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 379% of the Medicare baseline (a markup of 279%). 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 | $22 | 208% |
| Medicaid / KanCare | $30 - $43 | 284% |
| Multiplan-All Plans | $39 | 369% |
| Wppa-All Plans | $40 | 379% |
| UnitedHealthcare | $41 | 388% |
| Midlands Choice-All Plans | $41 | 388% |
| Health Partners Of Ks Ppo-All Plans | $41 | 388% |
Consumer Guidance & Cost Commentary
For the comprehensive metabolic panel (CPT 80053) at Smith County Memorial Hospital in Smith Center, KS, the cash price is $43.00, which matches the facility's gross charge. This rate is significantly higher than the state average for this service, which is $39.00. While Medicaid / KanCare plans negotiate a range of $30 to $43, the cash price remains the lowest option for patients without insurance. For individuals with high-deductible plans, paying the full cash price of $43.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates for most commercial payers exceed this amount. Patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full before services are rendered.
When comparing this facility's pricing to Medicare, the cash rate of $43.00 is 3.8 times the Medicare benchmark of $10.56. This markup reflects the administrative costs and profit margins inherent in commercial billing, which often exceed the true cost of care represented by Medicare rates. Although the facility is a Critical Access Hospital owned by the local government, the lack of a published facility rating means further verification of quality metrics is not available in this report. Consumers are advised to request an itemized bill to ensure no errors or unbundled charges exist, as over 80% of hospital bills contain discrepancies. If a patient receives a balance bill from an out-of-network provider at this in-network facility, they may be entitled to protections under the No Surprises Act, which bans balance