CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Children's Hospital of Philadelphia

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $171
Cash Discount Price: $411
vs. Medicare Baseline: 16.19x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Children's Hospital of Philadelphia is $171. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $411. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 16.19x the Medicare baseline. Located in 3401 Civic Center Blvd, Philadelphia, PA.

Cash / Self-Pay

$411

Average discount available for prompt cash payment at this facility.

Insurance Median

$171

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: $411 (3892%)

Insurance Median: $171 (1619%)

Cash: $411 (3892% of Medicare)

Ins. Median: $171 (1619% 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 1619% of the Medicare baseline (a markup of 1519%). 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
Geisinger Medical Assistance	$16	152%
Highmark Wholecare	$18	170%
Horizon Nj Health	$52	492%
Medicaid / KanCare	$57 - $79	540%
UnitedHealthcare	$57 - $264	540%
Health Partners	$65 - $90	616%
Aetna	$81 - $240	767%
Upmc Medical Assistance	$94 - $131	890%
Keystone First Chip	$106 - $149	1004%
Keystone Health Plan East	$108 - $152	1023%
Blue Cross Blue Shield	$121 - $192	1146%
Geisinger Health Plan Commercial	$151 - $211	1430%
Jefferson Health Plans	$162 - $227	1534%
Cigna	$171 - $240	1619%
Highmark	$171 - $240	1619%
Qualcare	$188 - $264	1780%
First Health Network	$223 - $312	2112%
Devon Health, Intergroup, Multiplan, Valley Preferred/Populytics	$274 - $384	2595%
Private Health Care Systems	$274 - $384	2595%
Choice Care Network	$308 - $432	2917%

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 $411.
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 Children's Hospital of Philadelphia 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.