CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: UPMC Kane

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $105
Cash Discount Price: $170
vs. Medicare Baseline: 9.94x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at UPMC Kane is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $170. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 9.94x the Medicare baseline. Located in 4372 Route 6, Kane, PA.

Cash / Self-Pay

$170

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

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: $170 (1610%)

Insurance Median: $105 (994%)

Cash: $170 (1610% of Medicare)

Ins. Median: $105 (994% 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 994% of the Medicare baseline (a markup of 894%). 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 Work Partners	$10	95%
Focus Healthcare	$12 - $269	114%
UnitedHealthcare	$13 - $115	123%
Aetna	$13 - $109	123%
UPMC Health Plan	$13 - $124	123%
Geisinger	$16	152%
Highmark Wholecare (Prev Gateway)	$17 - $113	161%
Amerihealth Caritas	$18 - $113	170%
PA Health & Wellness	$20	189%
Blue Cross Blue Shield	$46 - $105	436%
Horizon Health Plan	$198	1875%
Cigna	$198 - $6,371	1875%
Multiplan	$212	2008%
Intergroup	$226	2140%
Health Coalition Partners	$226	2140%

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 $170.
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 Kane 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.