CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: UW Health

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $135
Cash Discount Price: $65
vs. Medicare Baseline: 12.78x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at UW Health is $135. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $65. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 12.78x the Medicare baseline. Located in 1401 East State Street, Rockford, IL.

Cash / Self-Pay

$65

Average discount available for prompt cash payment at this facility.

Insurance Median

$135

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: $65 (616%)

Insurance Median: $135 (1278%)

Cash: $65 (616% of Medicare)

Ins. Median: $135 (1278% 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 1278% of the Medicare baseline (a markup of 1178%). 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
Aetna	$11 - $201	104%
Blue Cross Blue Shield	$11 - $138	104%
Humana	$11	104%
Medicare (plans)	$11 - $12	104%
Mychoice Wi Medical Adv	$11	104%
UnitedHealthcare	$11 - $17	104%
Quartz Fully Insured	$13 - $97	123%
Quartz Aso	$15 - $152	142%
Ecoh	$21 - $219	199%
Hfn	$21 - $219	199%
Alliance Premier Network	$135 - $152	1278%
The Alliance	$173 - $196	1638%
Wps Ppo	$191 - $215	1809%
Cigna	$197 - $222	1866%
Beloit Healt System	$223 - $251	2112%
Mercycare	$230 - $260	2178%
First Health/Coventry	$243 - $274	2301%
Health Payment Systems	$288 - $325	2727%
Healthsmart	$288 - $325	2727%
Sheboygan Employers Health Network	$307 - $346	2907%
Multiplan	$343 - $387	3248%

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 $65.
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 UW Health 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.