Comprehensive metabolic panel at Good Samaritan Hospital (GSH). CPT 80053.
What Good Samaritan Hospital (GSH) publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$115cash price (self-pay)
$191list price
$5.00–$191range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Aetna | Medicare Advantage | $10.56 |
| Allwell | MCR ADV/PPO/HMO | $10.56 |
| Anthem HIP | HIP | $10.56 |
| Anthem MCR | MCR ADV/PPO/HMO | $10.56 |
| Anthem MCR | Medicare Advantage | $10.56 |
| Anthem | MCR ADV/PPO/HMO | $10.56 |
| Anthem | Medicaid | $10.56 |
| BCBS | Medicare Advantage | $10.56 |
| Caresource HIP | Medicaid | $10.56 |
| Caresource | Medicaid | $10.56 |
| Cigna | Medicare Advantage | $10.56 |
| Humana | Medicare Advantage | $10.56 |
| United Healthcare | Medicare Advantage | $10.56 |
| Aetna | Medicaid | $10.56 |
| Anthem Pathways | Medicaid | $10.56 |
| Indiana University | MCR ADV/PPO/HMO | $10.56 |
| MHS Ambetter | Commercial | $10.56 |
| Alliance Coal | Commercial | $13.20 |
| CareSource | Commercial | $14.52 |
| Encore Prime | Commercial | $15.92 |
| Aetna | Commercial | $17.74 |
| Hope Trust | Commercial | $21.12 |
| Anthem | Trad/PPO/HMO | $70.61 |
| Direct Health | Direct Health | $78.53 |
| OneCare | Commercial | $79.63 |
| Anthem | HealthSync | $87.41 |
| Amish | Commercial | $95.50 |
| HealthLink | HMO | $101 |
| HealthLink | PPO | $107 |
| Anthem | Exchange | $109 |
Inpatient
$115cash price (self-pay)
$191list price
$111–$191range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem | Exchange | $111 |
| United Healthcare | Commercial | $126 |
| Anthem | Trad/PPO/HMO | $139 |
| Direct Health | Direct Health | $147 |
| SIHO | Commercial | $147 |
| Cigna | Commercial | $151 |
| Sagamore | Commercial | $151 |
| Corvel | Workers Comp | $157 |
| Aetna | Commercial | $160 |
| Anthem | HealthSync | $164 |
| HealthLink | HMO | $168 |
| Encore Prime | Commercial | $172 |
| Humana | Commercial | $172 |
| HealthLink | PPO | $178 |
| Molina | Medicaid | $191 |
| Underwriters Safety | Commercial | $191 |
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