CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Munson Healthcare Otsego Memorial Hospital

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $28
Cash Discount Price: $119
vs. Medicare Baseline: 2.65x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Munson Healthcare Otsego Memorial Hospital is $28. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $119. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 2.65x the Medicare baseline. Located in 825 N Center Ave, Gaylord, MI.

Cash / Self-Pay

$119

Average discount available for prompt cash payment at this facility.

Insurance Median

$28

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: $119 (1127%)

Insurance Median: $28 (265%)

Cash: $119 (1127% of Medicare)

Ins. Median: $28 (265% 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 265% of the Medicare baseline (a markup of 165%). 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
UnitedHealthcare	$4 - $112	38%
Blue Cross Blue Shield	$6 - $87	57%
Mclaren Health Plan	$6 - $117	57%
Meridian	$6	57%
Molina	$6 - $11	57%
Priority Health	$6 - $28	57%
Aetna	$9 - $113	85%
Blue Care Network	$11	104%
Cigna	$11 - $28	104%
Hap (Health Alliance Plan)	$11 - $112	104%
Humana	$11	104%
Medicare (plans)	$11	104%
Michigan Amish Medical Board	$11	104%
Northern Michigan Mennonite Group	$11	104%
Employee Benefit Logistics	$18	170%
Hospice Of Michigan	$84	795%
Munson Hospice	$98 - $852	928%
Asr Physicians Care Network	$112	1061%
Enterprise Group Planning/Employee Benefit Plan	$112	1061%
Nomi Health	$112	1061%
Cofinity	$119 - $126	1127%
Provider Network Of America/Hawaii Mainland Administrative Group Health	$119	1127%
Three Rivers Provider Network	$119	1127%

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 $119.
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 Munson Healthcare Otsego 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.