CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Unity Physicians Hospital

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $21,318
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2018.75x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Unity Physicians Hospital is $21,318. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 2018.75x the Medicare baseline. Located in 4455 Edison Lakes Pkwy, Mishawaka, IN.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$21,318

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%)

Insurance Median: $21,318 (201875%)

Ins. Median: $21,318 (201875% 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 201875% of the Medicare baseline (a markup of 201775%). 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
Blue Cross Blue Shield	$11 - $33,080	104%
Medicaid / KanCare	$11	104%
Mhs Hoosier Care Connect	$11	104%
Nalc	$156 - $44,702	1477%
Sagamore Health Network	$156 - $44,702	1477%
Multiplan	$169	1600%
Multiplan Wc	$208	1970%
Aarp Supplemental	$21,318	201875%
Aetna	$21,318	201875%
Cigna	$21,318	201875%
Department Of Va	$21,318	201875%
Medicare (plans)	$21,318	201875%
Mhs Healthy Indiana Plan	$21,318	201875%
Railroad Retirement	$21,318	201875%
UnitedHealthcare	$21,318 - $44,702	201875%
Three Rivers Provider Network	$25,581	242244%
Humana	$29,845	282623%
Encore	$38,372	363371%
Provider Network Of America	$42,635	403741%
All Savers	$44,702	423314%
Medica	$44,702	423314%
Medica Ifb	$44,702	423314%
Oxford	$44,702	423314%

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 $X.
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 Unity Physicians 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.