CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Elmhurst Hospital Center

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $51
Cash Discount Price: Unavailable
vs. Medicare Baseline: 4.83x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Elmhurst Hospital Center is $51. 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 4.83x the Medicare baseline. Located in 79-01 Broadway, Elmhurst, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$51

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: $51 (483%)

Ins. Median: $51 (483% 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 483% of the Medicare baseline (a markup of 383%). 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
Aetna	$7 - $28	66%
Healthfirst	$8 - $114	76%
Elderplan	$11	104%
Fidelis	$11 - $114	104%
Magnacare	$13	123%
Oxford	$15	142%
United	$15 - $63	142%
Oscar	$16	152%
Centerlight	$20	189%
Wellcare	$24	227%
Carelon	$26 - $51	246%
Cigna	$26	246%
Emblem	$28 - $68	265%
Multiplan	$32	303%
Local 1199	$34	322%
Villagecare Max	$34	322%
Vnsny	$34 - $52	322%
Blue Cross Blue Shield	$35 - $114	331%
Metroplus	$47 - $114	445%
Amidacare	$51	483%
Senior Whole Health	$51	483%
United Behavioral Health	$51 - $56	483%
Affinity	$52 - $114	492%
Carelon (Amida Care)	$52	492%

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 Elmhurst Hospital Center 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.