Comprehensive metabolic panel at St. Luke's Jerome Standard Charges. CPT 80053.

What St. Luke's Jerome Standard Charges publishes for this service, straight from its standard-charges file, last updated March 25, 2026.

Outpatient / ER

$47.00cash price (self-pay)

$47.00list price

$10.56–$44.65range insurers pay

Insurance plan	Negotiated rate
Slplan Tap Mc St Lukes Health Plan [1641000001] \| Hb Mv Slhp St Lukes	$10.56
Blue Cross Idaho [1007] \| Hb Mv Slhp Blue Cross Carepoint Qhp	$10.56
Blue Cross Idaho [1007] \| Hb Mv Slhp Blue Cross Large Group	$10.56
Commercial [1028] \| Hb Mv Slhp Mountain Health Coop	$10.56
Commercial [1028] \| Hb Mv Slhp Select Health	$10.56
Commercial [1028] \| Hb Mv Slhp Select Health Qhp	$10.56
Commercial [1028] \| Hb Mv Va Ccn	$10.56
Medicare Advantage Generic [1019] \| Hb Mv Medicare Advantage	$10.56
Medicare Advantage Generic [1019] \| Hb Mv Molina Mmcp	$10.56
Medicare Advantage Molina [1053] \| Hb Mv Molina Mmcp	$10.56
Medicare Advantage Pacificsource [1039] \| Hb Mv Pacificsource HMO PPO	$10.56
Medicare Advantage Pacificsource [1039] \| Hb Mv Slhp Pacificsource Med	$10.56
Medicare Advantage Regence [1016] \| Hb Mv Medicare Advantage	$10.56
Blue Cross/Medicare Advantage [1009] \| Hb Mv Bci True & Secure Med Adv	$10.67
Medicare Advantage Generic [1019] \| Hb Mv Molina Med Adv	$10.77
Medicare Advantage Molina [1053] \| Hb Mv Molina Med Adv	$10.77
Medicare Advantage Aetna [1017] \| Hb Mv Aetna Med Adv	$11.62
Blue Cross Out Of State [1041] \| Hb Mv Bci Out Of State	$23.76
Blue Shield Alt [100401] \| Hb Mv Regence Out Of State	$23.76
Commercial [1028] \| Hb Mv Regence PPO & Traditional	$23.76
Commercial [1028] \| Hb Mv H2b	$35.25
H2b [1068] \| Hb Mv H2b	$35.25
Aetna [1021] \| Hb Mv Bp Aetna	$37.60
Cigna [1062] \| Hb Mv Cigna	$37.60
Commercial [1028] \| Hb Mv Bp Aetna	$37.60
Commercial [1028] \| Hb Mv Cigna	$37.60
Commercial [1028] \| Hb Mv Multiplan Primary Network	$37.60
Commercial [1028] \| Hb Mv Amps	$39.95
Commercial [1028] \| Hb Mv Christian Health Aid	$39.95
Commercial [1028] \| Hb Mv First Choice Health	$39.95

Inpatient

$81.00cash price (self-pay)

$81.00list price

$52.65–$76.95range insurers pay

Insurance plan	Negotiated rate
Slplan Tap Mc St Lukes Health Plan [1641000001] \| Hb Mv Slhp St Lukes	$52.65
Blue Cross Idaho [1007] \| Hb Mv Slhp Blue Cross Carepoint Qhp	$52.65
Blue Cross Idaho [1007] \| Hb Mv Slhp Blue Cross Large Group	$52.65
Commercial [1028] \| Hb Mv Slhp Mountain Health Coop	$52.65
Commercial [1028] \| Hb Mv Slhp Select Health	$52.65
Commercial [1028] \| Hb Mv Slhp Select Health Qhp	$52.65
Medicare Advantage Pacificsource [1039] \| Hb Mv Slhp Pacificsource Med	$52.65
Mountain Health Co-Op [1067] \| Hb Mv Slhp Mountain Health Coop	$52.65
Pacificsource [1020] \| Hb Mv Pacificsource Navigator Large Group	$52.65
Pacificsource [1020] \| Hb Mv Slhp Pacificsource Navigator Qhp	$52.65
Select Health [1063] \| Hb Mv Slhp Select Health	$52.65
Select Health [1063] \| Hb Mv Slhp Select Health Qhp	$52.65
St Lukes Health Plan [1046] \| Hb Mv Slhp St Lukes Health Plan Large Gr	$52.65
St Lukes Health Plan [1046] \| Hb Mv Slhp St Lukes Health Plan Qhp	$52.65
Commercial [1028] \| Hb Mv H2b	$60.75
H2b [1068] \| Hb Mv H2b	$60.75
Pacificsource [1020] \| Hb Mv Pacificsource PPO Voyager	$60.75
Aetna [1021] \| Hb Mv Bp Aetna	$64.80
Cigna [1062] \| Hb Mv Cigna	$64.80
Commercial [1028] \| Hb Mv Bp Aetna	$64.80
Commercial [1028] \| Hb Mv Cigna	$64.80
Commercial [1028] \| Hb Mv Multiplan Primary Network	$64.80
Commercial [1028] \| Hb Mv Va Ccn	$64.80
Providence [1022] \| Hb Mv Cigna	$64.80
Commercial [1028] \| Hb Mv Amps	$68.85
Commercial [1028] \| Hb Mv Christian Health Aid	$68.85
Commercial [1028] \| Hb Mv First Choice Health	$68.85
First Health [1064] \| Hb Mv First Choice Health	$68.85
Blue Cross Federal [1008] \| Hb Mv Bci PPO Fep	$69.26
Blue Cross Idaho [1007] \| Hb Mv Bci PPO Fep	$69.26

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All common services at St. Luke's Jerome Standard Charges