CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $731
Cash Discount Price: $933
vs. Medicare Baseline: 69.22x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at UPMC Children's Hospital of Pittsburgh is $731. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $933. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 69.22x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$933

Average discount available for prompt cash payment at this facility.

Insurance Median

$731

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: $933 (8835%)

Insurance Median: $731 (6922%)

Cash: $933 (8835% of Medicare)

Ins. Median: $731 (6922% 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 6922% of the Medicare baseline (a markup of 6822%). 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
Aetna	$9 - $855	85%
Amerihealth Caritas	$11 - $44	104%
Blue Cross Blue Shield	$11 - $120	104%
Cigna	$11 - $855	104%
Health Plan Of Upper Ohio Valley	$11 - $1,011	104%
Upmc Health Plan	$27 - $89	256%
Health Partners Plans (Jefferson Health Plan)	$45	426%
UnitedHealthcare	$46 - $731	436%
Highmark Wholecare (Prev Gateway)	$47	445%
Pa Health & Wellness	$47	445%
Geisinger	$48 - $699	455%
Intergroup	$1,011 - $1,322	9574%
Coventry/First Health	$1,244	11780%
Saudi Armed Forces	$1,244	11780%
Health Payors Organization	$1,322	12519%
Multiplan	$1,322	12519%
National Provider Network	$1,400	13258%
Private Health Care Systems	$1,400	13258%

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 $933.
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 Children's Hospital of Pittsburgh 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.