Blood test, comprehensive metabolic panel
Facility: Oakleaf Surgical Hospital
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $11
- Cash Discount Price: $103
- 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 |
|---|---|---|
| Blue Cross Blue Shield | $11 | 104% |
| Dean Health Plan | $11 | 104% |
| Group Health Cooperative Of Eau Claire | $11 | 104% |
| Healthpartners | $11 | 104% |
| Humana | $11 | 104% |
| Medica | $11 | 104% |
| Quartz Health Solutions | $11 | 104% |
| Security Health Plan Of Wi | $11 | 104% |
| Ucare Wi | $11 | 104% |
| UnitedHealthcare | $11 | 104% |
Consumer Guidance & Cost Commentary
For this comprehensive metabolic panel at Oakleaf Surgical Hospital in Altoona, WI, the most significant benchmark is the Medicare rate of $10.56, which serves as the scientifically validated baseline for hospital pricing. While the facility's cash payment rate is listed at $103 and the gross charge is $114, patients should be aware that commercial insurance negotiated rates for this service average $11 across ten payers, which is notably higher than the cash price. This pricing structure suggests that for patients with high-deductible plans, paying the cash rate of $103 upfront may be more cost-effective than relying on insurance, which would likely result in a higher allowed amount due to administrative overhead and contract dynamics.
To minimize out-of-pocket costs, patients are encouraged to verify if the hospital offers "self-pay" or "prompt-pay" discounts, which can provide a fee reduction of 20% to 50% for upfront payment by bypassing costly claims processing. It is also important to note that while the facility is an Acute Care Hospital owned by a Physician group, the data does not include a specific state or county average comparison for this CPT code, so the Medicare benchmark of $10.56 remains the primary reference point for evaluating fair pricing. Consumers should request an itemized billing audit before finalizing payment to ensure no errors or unbundled charges are included in the final statement.