Blood test, comprehensive metabolic panel
Facility: Regional Medical Center
Billing Code: 80053 (CPT)
- CPT Billing Code: 80053
- Insurance Median: $870
- Cash Discount Price: $122
- vs. Medicare Baseline: 82.39x 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 8239% of the Medicare baseline (a markup of 8139%). 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 |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 8239% |
Consumer Guidance & Cost Commentary
For patients paying cash directly, the most important thing to know is that this comprehensive metabolic panel costs exactly $122 at Regional Medical Center in Manchester, Iowa, which is significantly lower than the facility's standard negotiated rate of $870. Since cash payments can sometimes be cheaper for individuals with high-deductible plans when the insurance negotiated rate exceeds the cash price, it is advisable to ask the hospital specifically about self-pay or prompt-pay discounts before scheduling your visit. These upfront payment incentives allow patients to bypass the administrative overhead and claims processing fees that typically inflate commercial rates, potentially reducing the final amount owed.
When comparing this price to broader benchmarks, the cash rate of $122 is notably lower than the facility's median negotiated rate of $870, while the facility's actual median paid rate to payers is $57, suggesting that commercial contracts may be structured differently than the cash offer. It is critical to remember that comparing your cost against the hospital's gross charge is misleading; instead, the most effective way to evaluate pricing is to look at the Medicare amount of $10.56, which serves as a scientifically validated cost baseline. Because the facility is a government-owned critical access hospital, understanding these distinct rates helps ensure you are not paying a markup that could be avoided through direct inquiry or by utilizing the itemized billing audit process to verify all charges before payment.