CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Progress West Hospital

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $233
Cash Discount Price: $215
vs. Medicare Baseline: 22.06x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Progress West Hospital is $233. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $215. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 22.06x the Medicare baseline. Located in 2 Progress Point Pkwy, Ofallon, MO.

Cash / Self-Pay

$215

Average discount available for prompt cash payment at this facility.

Insurance Median

$233

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: $215 (2036%)

Insurance Median: $233 (2206%)

Cash: $215 (2036% of Medicare)

Ins. Median: $233 (2206% 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 2206% of the Medicare baseline (a markup of 2106%). 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	$11 - $267	104%
Healthscope Benefits [258]	$13	123%
Cigna	$15 - $23	142%
Aetna	$18 - $269	170%
Allied Benefits [498]	$18 - $267	170%
Consociate [478]	$18	170%
Coresource [497]	$18	170%
Fmh Benefit Service Inc [222]	$18	170%
Mail Handlers [495]	$18	170%
Sarah Bush Lincoln [636]	$18	170%
Apwu Health Plan [216]	$23	218%
Nalc Health Benefit Plan [242]	$23	218%
Priority Health [648]	$23	218%
Blue Cross Blue Shield	$25 - $312	237%
Humana	$29	275%
Healthlink [225]	$174 - $271	1648%
Cox Health Systems Insurance Company [220]	$197 - $233	1866%
Health Alliance [224]	$197	1866%
Hope Trust [806]	$208	1970%
Med-Pay [480]	$233 - $269	2206%
Unicare [568]	$233 - $271	2206%
First Health Commercial [734]	$267	2528%
Beechstreet [551]	$269	2547%
Detego Health [868]	$269	2547%
Health Systems Inc [620]	$269	2547%
Healthcare Sol Mercy [609]	$269	2547%
Multiplan Commercial [737]	$269	2547%
Multiplan [240]	$269	2547%
Phcs [244]	$269 - $287	2547%
Preferred Health Professionals [561]	$271	2566%
Hfn [563]	$287	2718%
Medica [661]	$287	2718%
Mh Magellan Health Services [270]	$359	3400%

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 $215.
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 Progress West 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.