CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Penn State Health St. Joseph

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $12
Cash Discount Price: $18
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Penn State Health St. Joseph is $12. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 1.14x the Medicare baseline. Located in 2500 Bernville Road, Reading, PA.

Cash / Self-Pay

$18

Average discount available for prompt cash payment at this facility.

Insurance Median

$12

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: $18 (170%)

Insurance Median: $12 (114%)

Cash: $18 (170% of Medicare)

Ins. Median: $12 (114% 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
[Amerihealth Caritas]	$9 - $11	85%
[Highmark Wholecare]	$9 - $11	85%
[Geisinger]	$10 - $50	95%
[Health Partners Plans]	$10 - $11	95%
[Highmark]	$10 - $40	95%
[Pa Health & Wellness]	$10 - $11	95%
Aetna	$11 - $29	104%
Humana	$11	104%
UnitedHealthcare	$11 - $47	104%
[Cbc]	$11 - $36	104%
[Healthspring]	$11	104%
[Ibc]	$11 - $34	104%
[Upmc]	$11 - $51	104%
[Point Comfort Underwriters]	$13	123%
Cigna	$31	294%
[Highmark Choice Blue]	$32	303%
[Highmark Aca]	$34	322%
[Preferred Healthcare Systems]	$52	492%
[First Health]	$55	521%
[Multiplan]	$55	521%

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 $18.
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 Penn State Health St. Joseph 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.