CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Nationwide Children's Hospital Toledo, LLC

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $32
Cash Discount Price: $269
vs. Medicare Baseline: 3.03x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Nationwide Children's Hospital Toledo, LLC is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $269. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 3.03x the Medicare baseline. Located in 2213 Cherry Street, Toledo, OH.

Cash / Self-Pay

$269

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

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: $269 (2547%)

Insurance Median: $32 (303%)

Cash: $269 (2547% of Medicare)

Ins. Median: $32 (303% 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 303% of the Medicare baseline (a markup of 203%). 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
Caresource	$11	104%
Mcclaren Health Plan - Michigan	$11	104%
Molina	$11 - $22	104%
Cigna	$17	161%
Amerihealth	$22	208%
Bchp	$22	208%
Blue Cross Blue Shield	$22 - $228	208%
Humana	$22	208%
UnitedHealthcare	$22 - $226	208%
Front Path Health Coalition	$32 - $202	303%
Mmo	$112 - $157	1061%
Aetna	$172	1629%
Mcclaren Health Plan	$202	1913%
Ohc	$224	2121%
Ohio Ppo Connect	$224	2121%
First Health	$345	3267%

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 $269.
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 Nationwide Children's Hospital Toledo, LLC 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.