CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Baylor Scott & White Medical Center Pflugerville

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $120
Cash Discount Price: $198
vs. Medicare Baseline: 11.36x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Baylor Scott & White Medical Center Pflugerville is $120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $198. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 11.36x the Medicare baseline. Located in 2600 East Pflugerville Parkway, Pflugerville, TX.

Cash / Self-Pay

$198

Average discount available for prompt cash payment at this facility.

Insurance Median

$120

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: $198 (1875%)

Insurance Median: $120 (1136%)

Cash: $198 (1875% of Medicare)

Ins. Median: $120 (1136% 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 1136% of the Medicare baseline (a markup of 1036%). 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
Baylor Scott & White Health Plan	$10 - $142	95%
American Health Plan	$11	104%
Corvel	$11	104%
Healthspring	$11	104%
Humana	$11 - $232	104%
Prime Health Services	$11	104%
Procare Advantage	$11	104%
Superior Health Plan	$11 - $60	104%
Triwest	$11	104%
UnitedHealthcare	$11 - $12	104%
Sedgwick	$16	152%
Blue Cross Blue Shield	$51 - $63	483%
Cigna	$157 - $183	1487%
Aetna	$182	1723%
Midcoast	$182	1723%
Quiktrip	$182	1723%
University Of Mary Hardin-Baylor	$192	1818%
Independent Medical System	$198	1875%
Curative	$215	2036%
First Health	$232	2197%
Healthsmart	$232 - $248	2197%
Private Health Care System	$248	2348%
Three Rivers	$298	2822%

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 $198.
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 Baylor Scott & White Medical Center Pflugerville 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.