CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: St John's Riverside Hospital

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $11
Cash Discount Price: $279
vs. Medicare Baseline: 1.04x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at St John's Riverside Hospital is $11. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $279. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 1.04x the Medicare baseline. Located in 976 North Broadway, Yonkers, NY.

Cash / Self-Pay

$279

Average discount available for prompt cash payment at this facility.

Insurance Median

$11

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: $279 (2642%)

Insurance Median: $11 (104%)

Cash: $279 (2642% of Medicare)

Ins. Median: $11 (104% 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.

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
Fidelis Health Benefit Exchange	$10	95%
Aetna	$11 - $3,783	104%
Centers Plan For Healthy Living	$11	104%
Fidelis	$11	104%
Fidelis Essential Plans	$11	104%
Healthfirst	$11	104%
Hip Health Plan	$11	104%
Magnacare	$11	104%
Medicaid / KanCare	$11	104%
Medicare (plans)	$11	104%
Metroplus Gold	$11	104%
Mvp	$11	104%
Mvp Bhs	$11	104%
Oscar	$11	104%
Partners Health Plan	$11	104%
United Behavioral Health Of Ny Ipa	$11	104%
Village Caremax	$11	104%
Wellcare	$11	104%
UnitedHealthcare	$13	123%
Emblem Health	$24	227%
Blue Cross Blue Shield	$37	350%
Mvp Individual Exchange.Student Health Plan	$37	350%
Cigna	$43	407%
Mvp Commercial	$44	417%

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 $279.
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 St John's Riverside 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.