Blood test, comprehensive metabolic panel
Facility: Bob Wilson Memorial Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $171
- Cash Discount Price: $84
- vs. Medicare Baseline: 16.19x 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 1619% of the Medicare baseline (a markup of 1519%). 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 |
|---|---|---|
| Centura Employee Plan | $13 | 123% |
| Blue Cross Blue Shield | $30 | 284% |
| Aetna | $67 - $167 | 634% |
| Humana | $67 | 634% |
| Kansas Health | $67 | 634% |
| Medicare (plans) | $67 | 634% |
| UnitedHealthcare | $67 - $174 | 634% |
| Multiplan | $188 - $194 | 1780% |
| Health Partners Of Kansas | $197 | 1866% |
| Wppa | $199 | 1884% |
Consumer Guidance & Cost Commentary
For the CPT code 80053, representing a comprehensive metabolic panel at Bob Wilson Memorial Hospital in Ulysses, Kansas, the negotiated rates vary significantly depending on your insurance carrier. While commercial payers like Aetna and UnitedHealthcare have negotiated rates ranging from $67 to $174, Medicare plans are covered at a fixed rate of $10.56. It is important to note that the facility's cash price of $84.00 is lower than the negotiated rates for most commercial insurers, including Multiplan and Health Partners Of Kansas. In cases where your insurance deductible has not yet been met, or if your plan has a high deductible, paying the cash price directly can often result in lower out-of-pocket costs compared to the insurance negotiated amount. Patients should verify if their specific plan allows for cash-pay discounts, as paying upfront can sometimes bypass the administrative overhead that inflates commercial rates.
The facility, a Critical Access Hospital owned by a voluntary non-profit church, has a cash median of $84.00 and a median negotiated rate of $171.00 across all payers. While the data provided does not include specific state or county average figures for comparison, the significant gap between the cash price and the highest negotiated rates (up to $199 for WPPA) highlights the potential for substantial savings through prompt-pay arrangements. Hospitals often offer prompt-pay discounts of 20% to 50% for patients who settle their bill in full within 30 days, effectively bypassing the costly claims processing cycle that insurance companies utilize. To secure these savings, patients should request a self-pay classification and a prompt-pay discount before scheduling their