CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: John Muir Medical Center - Walnut Creek Campus

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $143
Cash Discount Price: $757
vs. Medicare Baseline: 13.54x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at John Muir Medical Center - Walnut Creek Campus is $143. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $757. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 13.54x the Medicare baseline. Located in 1601 Ygnacio Valley Rd, Walnut Creek, CA.

Cash / Self-Pay

$757

Average discount available for prompt cash payment at this facility.

Insurance Median

$143

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: $757 (7169%)

Insurance Median: $143 (1354%)

Cash: $757 (7169% of Medicare)

Ins. Median: $143 (1354% 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 1354% of the Medicare baseline (a markup of 1254%). 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
Contra Costa County Jail [1012104]	$9	85%
Health Net-Network Mcare [1028127]	$10	95%
Aetna	$11 - $1,216	104%
Alignment Health [1177113]	$11	104%
Blue Cross Blue Shield	$11 - $1,093	104%
Blue Shield-Network Mcare [1006127]	$11	104%
Care 1St Health Plan [1094113]	$11	104%
Caremore [1171113]	$11	104%
Covid19 Hrsa Uninsured Testing And Treatment Fund [1179012]	$11	104%
Easy Choice Health Plan [1083113]	$11	104%
Essence Healthcare [1049028]	$11	104%
Essence Healthcare [1049128]	$11	104%
Golden State-Network Mcare [1023127]	$11	104%
Hospice Of East Bay [1085104]	$11	104%
Humana	$11 - $1,395	104%
Medicare (plans)	$11 - $1,345	104%
Scan-Network Mcare [1043127]	$11	104%
UnitedHealthcare	$11 - $983	104%
Veterans Administration [1051113]	$11	104%
Jmpn Canopy Hn [1640000011]	$12	114%
Generic Commercial/Indemnity [1017001]	$13 - $673	123%
Generic Hmo [1018103]	$13	123%
Generic Ppo [1021104]	$13	123%
Canopy Hn Hmo [1166103]	$19	180%
Brms [1091104]	$143	1354%
Delta Health Systems [1032104]	$143	1354%
Empire Plan [1092104]	$143	1354%
Healthcomp [1089104]	$143 - $1,429	1354%
Carecentrix [1011001]	$673	6373%
Aps Healthcare [1003103]	$757	7169%
United Behavioral Health [1048103]	$845	8002%
Cigna	$854 - $1,204	8087%
Carelon Behavioral Health [1050104]	$925	8759%
Fortified Provider Network [1063104]	$925	8759%
Medigap [1036001]	$925	8759%
Three Rivers Provider Network [1073104]	$925	8759%
Health Net Hmo [1028103]	$959	9081%
Health Net-Network [1028026]	$959	9081%
Contra Costa Health Plan Hmo [1013103]	$1,009	9555%
Blue Shield Hmo [1006103]	$1,042 - $1,068	9867%
Blue Shield-Network [1006026]	$1,042 - $1,068	9867%
Blue Shield Ppo [1006104]	$1,118 - $1,237	10587%
Western Health Advantage Hmo [1053103]	$1,177 - $1,345	11146%
Health Net Ppo [1028104]	$1,221	11563%
Federal Correction Institute [1062104]	$1,345	12737%
First Health [1016104]	$1,345 - $1,429	12737%
Healthsmart - Pka Interplan [1031104]	$1,345	12737%
National Provider Network/Plancare America [1069104]	$1,345	12737%
Networks By Design [1084104]	$1,345	12737%
Pponext [1072104]	$1,345	12737%
Sutter Preferred Health Plan [1044104]	$1,345	12737%
Kaiser Hmo [1033103]	$1,362	12898%
Health Management Network [1066104]	$1,429	13532%
Galaxy Health Network [1064104]	$1,513	14328%
Integrated Health Plan [1075104]	$1,513	14328%
Donor Network West [1008103]	$4,000 - $12,000	37879%

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 $757.
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 John Muir Medical Center - Walnut Creek Campus 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.