CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Pocahontas Memorial Hospital

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $101
Cash Discount Price: $48
vs. Medicare Baseline: 9.56x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Pocahontas Memorial Hospital is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $48. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 9.56x the Medicare baseline. Located in 150 Duncan Road, Buckeye, WV.

Cash / Self-Pay

$48

Average discount available for prompt cash payment at this facility.

Insurance Median

$101

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: $48 (455%)

Insurance Median: $101 (956%)

Cash: $48 (455% of Medicare)

Ins. Median: $101 (956% 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 956% of the Medicare baseline (a markup of 856%). 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
Unicare Health Plan of Wv, Inc. - Commercial-Hmo	$94	890%
Aetna	$94 - $97	890%
Wellpoint West Virginia, Inc. - Commercial-Hmo	$94	890%
Medicaid / KanCare	$94	890%
UnitedHealthcare	$98 - $126	928%
Medicare (plans)	$99 - $102	938%
Highmark Senior Solutions Company - Commercial-Ppo	$100	947%
Wv Treasury Peia - Commercial-Ppo	$104	985%
The Health Plan - Commercial-Hmo	$104	985%
Blue Cross Blue Shield	$117	1108%
Humana	$132	1250%

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 $48.
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 Pocahontas Memorial Hospital 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.