Blood test, comprehensive metabolic panel
Facility: Golden Valley Memorial Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $11
- Cash Discount Price: $142
- vs. Medicare Baseline: 1.04x 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.
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 |
|---|---|---|
| Home State Health | $10 | 95% |
| UnitedHealthcare | $10 - $18 | 95% |
| Aetna | $11 | 104% |
| Humana | $11 | 104% |
| Ambetter / Centene | $13 | 123% |
Consumer Guidance & Cost Commentary
For patients paying cash out-of-pocket, the most important takeaway is that this comprehensive metabolic panel test carries a median cash price of $142, which is significantly lower than the facility's gross chargemaster rate of $236. While Golden Valley Memorial Hospital in Clinton, MO, is a government-owned acute care facility with a 3-star rating, the cash price remains the primary benchmark for self-pay patients. Although the data shows a median negotiated rate of $11 for UnitedHealthcare plans, commercial insurance rates can vary widely; for instance, Home State Health and Ambetter/Centene also pay $10 and $13 respectively, while UnitedHealthcare, Aetna, and Humana have negotiated rates ranging from $11 to $18. Patients with high-deductible plans should consider that paying $142 directly might result in lower out-of-pocket costs compared to their insurance allowed amount if the negotiated rate exceeds the cash price, making it financially prudent to ask the hospital specifically about "self-pay" or "prompt-pay" discounts before scheduling.
When evaluating the value of this service, it is essential to compare prices against the national baseline rather than the hospital's inflated list price. The Medicare benchmark for this CPT code is $10.56, which serves as the scientifically validated "true cost" of delivery under the CMS Prospective Payment System. In this specific case, the cash price of $142 is approximately 13.4 times the Medicare rate, highlighting that commercial rates often include significant administrative markups. Because over 80% of hospital bills contain errors, patients should never accept a summary bill as final; instead, they should request a full item