CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: UPMC St Margaret

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $48
Cash Discount Price: $100
vs. Medicare Baseline: 4.55x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at UPMC St Margaret is $48. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $100. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 4.55x the Medicare baseline. Located in 815 Freeport Road, Pittsburgh, PA.

Cash / Self-Pay

$100

Average discount available for prompt cash payment at this facility.

Insurance Median

$48

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: $100 (947%)

Insurance Median: $48 (455%)

Cash: $100 (947% of Medicare)

Ins. Median: $48 (455% 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 455% of the Medicare baseline (a markup of 355%). 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
Upmc Health Plan	$9 - $20	85%
Upmc Work Partners	$10	95%
Aetna	$11 - $67	104%
Highmark Wholecare (Prev Gateway)	$11 - $17	104%
Pa Health & Wellness	$11 - $20	104%
UnitedHealthcare	$13	123%
Amerihealth Caritas	$18	170%
Blue Cross Blue Shield	$28 - $132	265%
Cigna	$47 - $67	445%
Coventry/First Health	$117	1108%
Private Health Care Systems	$134	1269%
Selectcare	$134	1269%
Humana	$142	1345%

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 $100.
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 UPMC St Margaret 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.