CMS Price Transparency Data
Blood test, comprehensive metabolic panel
Facility: Trinity Health Oakland Hospital
Billing Code: 80053 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 80053
- Insurance Median: $86
- Cash Discount Price: $83
- vs. Medicare Baseline: 8.14x Medicare
The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Trinity Health Oakland Hospital is $86. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $83. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 8.14x the Medicare baseline. Located in 44405 Woodward Ave, Pontiac, MI.
Cash / Self-Pay
$83
Average discount available for prompt cash payment at this facility.
Insurance Median
$86
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: $83 (786%)
Insurance Median: $86 (814%)
Cash: $83 (786% of Medicare)
Ins. Median: $86 (814% 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 814% of the Medicare baseline (a markup of 714%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 | $6 - $21 | 57% |
| Medicaid / KanCare | $6 | 57% |
| Aetna | $10 - $58 | 95% |
| Blue Care Network Advantage | $10 | 95% |
| Medicare (plans) | $10 - $11 | 95% |
| Align Senior Care | $11 | 104% |
| Cca - Zing Health | $11 | 104% |
| Hospice Advantage | $11 | 104% |
| UnitedHealthcare | $11 - $95 | 104% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $12 | 114% |
| Molina Marketplace | $14 | 133% |
| Geha | $16 - $95 | 152% |
| Health Cost Solutions | $16 | 152% |
| Medical Mutual | $16 | 152% |
| Meritain | $16 | 152% |
| Priority Health | $16 - $17 | 152% |
| Vitalcore | $16 | 152% |
| Wellpath | $16 | 152% |
| Bcn Domestic | $21 | 199% |
| Blue Benefit Administrators Of Massachusetts | $21 | 199% |
| Blue Care Network | $21 | 199% |
| Blue Distinction Transplant | $21 | 199% |
| Blue Shield - Ca | $21 | 199% |
| Blue Shield - Id (Regence) | $21 | 199% |
| Blue Shield - Ny Highmark Northeastern | $21 | 199% |
| Blue Shield - Ny Highmark Western | $21 | 199% |
| Blue Shield - Pa (Highmark) | $21 | 199% |
| Blue Shield - Wa (Regence) | $21 | 199% |
| Health Choices | $21 - $93 | 199% |
| Kaiser Domestic | $21 | 199% |
| U Of M Health Plan | $23 | 218% |
| Employee Benefit Logistic | $24 | 227% |
| Asr Health Benefits | $35 | 331% |
| Caresource | $35 | 331% |
| Hap | $35 - $92 | 331% |
| Varipro | $35 | 331% |
| Wc Accident Fund | $39 | 369% |
| Wc Advantage | $39 | 369% |
| Wc Aig | $39 | 369% |
| Wc Allied | $39 | 369% |
| Wc Amerisure | $39 | 369% |
| Wc Amtrust | $39 | 369% |
| Wc Asu Risk Mgt | $39 | 369% |
| Wc Berkley Admin | $39 | 369% |
| Wc Broadspire | $39 | 369% |
| Wc Bunch & Associates | $39 | 369% |
| Wc Ccmsi | $39 | 369% |
| Wc Emc Insurance Company | $39 | 369% |
| Wc Esis | $39 | 369% |
| Wc Fcci | $39 | 369% |
| Wc Federated | $39 | 369% |
| Wc Gallagher Bassett | $39 | 369% |
| Wc Genex Care For Ohio | $39 | 369% |
| Wc Guard Insurance Company | $39 | 369% |
| Wc Hartford | $39 | 369% |
| Wc Liberty Mutual | $39 | 369% |
| Wc Meijers | $39 | 369% |
| Wc Michigan | $39 | 369% |
| Wc Mitchell Frankenmuth | $39 | 369% |
| Wc Pma | $39 | 369% |
| Wc Sedgwick | $39 | 369% |
| Wc Sentry | $39 | 369% |
| Wc Travelers | $39 | 369% |
| Wc Tristar | $39 | 369% |
| Wc Walmart | $39 | 369% |
| Wc Zurich | $39 | 369% |
| Acs Benefit Services | $56 | 530% |
| Allied Benefit Systems | $56 | 530% |
| Claimchoice Adminstrators | $56 | 530% |
| Consociate | $56 | 530% |
| Cypress Benefit Administrators | $56 | 530% |
| Forest County Potawatomi | $56 | 530% |
| Health Smart | $56 | 530% |
| Healthgram | $56 | 530% |
| Healthscope | $56 | 530% |
| Secureone Preferred United Plans | $56 | 530% |
| Sisco Benefits | $56 | 530% |
| The Health Plan | $56 | 530% |
| Trustmark Small Business Benefits | $56 | 530% |
| Unified Group Services | $56 | 530% |
| Webtpa | $56 | 530% |
| Mclaren Health | $61 - $67 | 578% |
| Carelon Behavioral Health | $64 | 606% |
| Magellan Behavioral Health | $76 | 720% |
| 1199 National Benefit Fund | $86 | 814% |
| Allied National Global Care | $86 | 814% |
| Asrm - Reliance Standard Life Insurance | $86 | 814% |
| Christian Care Ministry | $86 | 814% |
| Dean Health | $86 | 814% |
| Fallon Health | $86 | 814% |
| Family Life Insurance Company | $86 | 814% |
| Ghc Scw | $86 | 814% |
| Group Pension Administrators | $86 | 814% |
| International Benefit Administrators | $86 | 814% |
| Lifetime Benefit Solutions | $86 | 814% |
| Manhattan Life | $86 | 814% |
| Medi Share | $86 | 814% |
| Multiplan | $86 | 814% |
| Mvp | $86 | 814% |
| Pai | $86 | 814% |
| Pan-American Life | $86 | 814% |
| Paramount Hmo | $86 | 814% |
| Phcs | $86 | 814% |
| Trinity Health Share | $86 | 814% |
| Health Partners | $92 | 871% |
| Tufts Health Plan | $92 | 871% |
| Access Health | $93 | 881% |
| Acclaim | $93 | 881% |
| Administrative Concepts | $93 | 881% |
| Allegeant | $93 | 881% |
| Ameriben | $93 | 881% |
| American Family | $93 | 881% |
| American Healthcare Alliance | $93 | 881% |
| American National | $93 | 881% |
| American Republic | $93 | 881% |
| Amerihealth | $93 | 881% |
| Aultcare | $93 | 881% |
| Automated Benefit Services | $93 | 881% |
| Auxiant | $93 | 881% |
| Benefit Administrative Systems,Llc | $93 | 881% |
| Boon Chapman | $93 | 881% |
| Cam Administrative Services | $93 | 881% |
| Christian Brother Services | $93 | 881% |
| Christian Brothers Holy Cross | $93 | 881% |
| Comprehensive Benefits | $93 | 881% |
| Continental Life Insurance | $93 | 881% |
| Custom Benefit Administrators | $93 | 881% |
| Employee Benefit Concepts | $93 | 881% |
| Employee Benefit Management | $93 | 881% |
| Enterprise Group Planning | $93 | 881% |
| Freedom Life Insurance Company | $93 | 881% |
| Group Administrators | $93 | 881% |
| Group Marketing Services | $93 | 881% |
| Guardian | $93 | 881% |
| Health America | $93 | 881% |
| Healthcare Management Admin | $93 | 881% |
| Healthez | $93 | 881% |
| Humana | $93 | 881% |
| Insight | $93 | 881% |
| Intercare | $93 | 881% |
| Jfp Benefit Management | $93 | 881% |
| Jp Farley Corporation | $93 | 881% |
| Key Benefit Administrator | $93 | 881% |
| Liberty Union Life Assurance Co | $93 | 881% |
| Lucent Health | $93 | 881% |
| Luminare Health | $93 | 881% |
| Luminare Health (Detroit) | $93 | 881% |
| Magnacare | $93 | 881% |
| Medben | $93 | 881% |
| Medcost | $93 | 881% |
| Mutual Health Services | $93 | 881% |
| Mutual Of Omaha | $93 | 881% |
| Ncas | $93 | 881% |
| Nippon Life Ins | $93 | 881% |
| Nova | $93 | 881% |
| Painters Union Insurance Fund | $93 | 881% |
| Physicians Mutual | $93 | 881% |
| Plumbers Local 98 Insurance Fund | $93 | 881% |
| Prairie States | $93 | 881% |
| Preferred One | $93 | 881% |
| Primary Physician Care | $93 | 881% |
| Professional Benefit Administrators | $93 | 881% |
| Siho Insurance Services | $93 | 881% |
| The Loomis Company | $93 | 881% |
| Unicare | $93 | 881% |
| Us Health And Life | $93 | 881% |
| Valenz | $93 | 881% |
| Western & Southern Financial Group | $93 | 881% |
| Wps | $93 | 881% |
| Cigna | $94 | 890% |
| Coventry | $96 | 909% |
| First Health | $96 | 909% |
| Prime Health Services | $102 | 966% |
| Three Rivers Provider Network | $114 | 1080% |
| Cmh Detroit Wayne Integrated Health Network | $127 | 1203% |
| Cmh Lenawee County | $127 | 1203% |
| Cmh Livingston County | $127 | 1203% |
| Cmh Misc | $127 | 1203% |
| Cmh Monroe County | $127 | 1203% |
| Cmh Oakland County | $127 | 1203% |
| Cmh Washtenaw County | $127 | 1203% |