CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Pawhuska Hospital, Inc

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $152
Cash Discount Price: $115
vs. Medicare Baseline: 14.39x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Pawhuska Hospital, Inc is $152. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $115. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 14.39x the Medicare baseline. Located in 1101 East 15Th Street, Pawhuska, OK.

Cash / Self-Pay

$115

Average discount available for prompt cash payment at this facility.

Insurance Median

$152

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.56 (100%)

Cash / Self-Pay: $115 (1089%)

Insurance Median: $152 (1439%)

Cash: $115 (1089% of Medicare)

Ins. Median: $152 (1439% of 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 1439% of the Medicare baseline (a markup of 1339%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
UnitedHealthcare	$20 - $149	189%
Community Care Comm - All Plans	$26	246%
Healthchoice Ip/Op Only - All Plans	$53	502%
Blue Cross Blue Shield	$98 - $176	928%
Aetna	$109 - $207	1032%
Tricare	$109 - $120	1032%
Wellcare Mcr Adv - All Plans	$109 - $120	1032%
Humana	$110 - $207	1042%
Healthcare Highways - All Plans	$122 - $135	1155%
Cigna	$128 - $141	1212%
Multiplan - All Plans	$141 - $155	1335%
Ambetter / Centene	$164 - $180	1553%
Preferred Commchoice Ip/Op Only - All Plans	$169 - $186	1600%
Soonerselect Mcaid - All Plans	$188 - $207	1780%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $115.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 80053.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Pawhuska Hospital, Inc is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 80053.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.