CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Shriners Hospitals for Children Northern Calif

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $12
Cash Discount Price: $99
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Shriners Hospitals for Children Northern Calif is $12. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $99. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 1.14x the Medicare baseline. Located in 2425 Stockton Boulevard, Sacramento, CA.

Cash / Self-Pay

$99

Average discount available for prompt cash payment at this facility.

Insurance Median

$12

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: $99 (938%)

Insurance Median: $12 (114%)

Cash: $99 (938% of Medicare)

Ins. Median: $12 (114% 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.

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
Aetna	$5 - $13	47%
Amerigroup Nv	$6	57%
Blue Cross Blue Shield	$6 - $16	57%
Ambetter / Centene	$7 - $15	66%
Health Plan Of Nv	$7	66%
Soonercare	$9	85%
Amerigroup Tx	$10	95%
Cigna	$11	104%
Coventry Cares Ky	$11	104%
Humana	$11	104%
Medicaid / KanCare	$11	104%
Molina Healthcare Of Ky	$11	104%
Molina Healthcare Of Ms	$11	104%
UnitedHealthcare	$11 - $15	104%
Amerihealth Caritas Nc	$12 - $15	114%
Amerihealth Caritas Sc	$12	114%
Caresource Of Oh	$12	114%
Gateway Health Plan	$12	114%
Providence Health Plan	$12	114%
Caresource Of Ga	$13	123%
Central California Alliance For Health	$13	123%
Health Plan Of San Joaquin	$13	123%
Healthchoice Of Oklahoma	$13	123%
Kaiser Permanente	$13 - $100	123%
Molina Healthcare Of Ca	$13	123%
Partnership Healthplan Of Ca	$13	123%
Wellcare Of Ga	$13	123%
Sana Benefits	$15	142%
Dignity Health	$536	5076%

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 $99.
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 Shriners Hospitals for Children Northern Calif 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.