CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Pulaski Memorial Hospital

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $99
Cash Discount Price: $213
vs. Medicare Baseline: 9.38x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Pulaski Memorial Hospital is $99. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $213. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 9.38x the Medicare baseline. Located in 616 E 13Th St, Winamac, IN.

Cash / Self-Pay

$213

Average discount available for prompt cash payment at this facility.

Insurance Median

$99

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: $213 (2017%)

Insurance Median: $99 (938%)

Cash: $213 (2017% of Medicare)

Ins. Median: $99 (938% 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 938% of the Medicare baseline (a markup of 838%). 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 - $203	104%
Caresource Mcaid Hhw	$11	104%
Cenpatico Mcaid Hhw - All Other Plans	$11	104%
Mdwise Mcaid Hcc	$11	104%
Mdwise Mcaid Hhw	$11	104%
Mhs Mcaid Hhw/Hcc	$11	104%
UnitedHealthcare	$11 - $241	104%
Ambetter / Centene	$94	890%
Caresource Mcaid Hip	$94	890%
Caresource Mcare Hmo	$94	890%
Cenpatico Mcaid Hip	$94	890%
Mdwise Mcaid Hip - All Other Plans	$94	890%
Mhs Mcaid Hip	$94	890%
Humana	$95 - $245	900%
Mhs Mcare Allwell	$95	900%
Aetna	$110	1042%
Caresource Exch Hmo Hix - All Other Plans	$118	1117%
Sagamore Rose Acre	$227	2150%
Sagamore - All Other Plans	$230	2178%
Encore Ppo - All Other Plans	$259	2453%
Community Health Alliance - All Plans	$271	2566%
Encore Workers Comp	$274	2595%
Multiplan - All Plans	$274	2595%
Cigna	$289	2737%

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 $213.
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 Pulaski Memorial 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.