Blood test, comprehensive metabolic panel
Facility: Neosho Memorial Regional Medical Center
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $78
- Cash Discount Price: $182
- vs. Medicare Baseline: 7.39x 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 739% of the Medicare baseline (a markup of 639%). 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 |
|---|---|---|
| Medicaid / KanCare | $11 | 104% |
| Blue Cross Blue Shield | $25 - $78 | 237% |
| Tricare | $75 | 710% |
| Humana | $78 | 739% |
| Va_Ccn | $78 | 739% |
| Aetna | $78 | 739% |
| Medicare (plans) | $78 | 739% |
| Medadv_Allwell | $78 | 739% |
| Medadv_Uhc | $78 | 739% |
| Ambetter / Centene | $82 | 777% |
| Wppa_Providrscare | $202 | 1913% |
| United | $202 | 1913% |
| Cigna | $231 | 2188% |
| Hpk | $231 | 2188% |
| Coventry | $231 | 2188% |
Consumer Guidance & Cost Commentary
For the comprehensive metabolic panel (CPT 80053) at Neosho Memorial Regional Medical Center in Chanute, Kansas, the cash price is $182, which is lower than the facility's negotiated rates for most major payers. While the median negotiated rate across 15 insurance plans is $78, this figure represents the maximum amount insurers agree to pay under contract, not the actual cost to the patient. For individuals with high-deductible plans who have not yet met their out-of-pocket threshold, paying the cash price of $182 upfront may be more cost-effective than relying on insurance, which could result in a higher out-of-pocket expense once deductibles are applied. It is important to note that the facility is a Critical Access Hospital with government-local ownership, and patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling to ensure they receive the lowest possible rate.
When evaluating the cost of this service, it is crucial to compare rates against the Medicare benchmark rather than the hospital's gross chargemaster price, as the latter is inflated to make discounts appear larger. The Medicare allowed amount for this procedure is $10.56, which serves as the objective baseline for fair pricing; commercial negotiated rates typically range from 200% to 300% of this figure, while fair pricing is generally defined as 120% to 150%. Although specific state or county average data was not provided in the source material, patients should be aware that itemized billing audits are the most effective tool for identifying errors, such as unbundled codes or services not rendered, which can significantly reduce medical debt. To avoid balance billing