Comprehensive metabolic panel at CHI Health Good Samaritan. CPT 80053.
What CHI Health Good Samaritan publishes for this service, straight from its standard-charges file, last updated February 28, 2026.
Outpatient / ER
$149cash price (self-pay)
$244list price
$10.23–$227range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Amerigroup | Medicaid|All Plans | $10.23 |
| Centene | Medicaid|IA Total Care | $10.23 |
| IAMolina | Medicaid|All Plans | $10.43 |
| BCBS - NE | Medicare|All Plans | $10.56 |
| Humana | Medicare|All Plans | $10.56 |
| Medica | Medicare|All Plans | $10.56 |
| PACE | Medicare|All Plans | $10.56 |
| United | Medicare|All Plans | $10.56 |
| Centene | Medicare|All Plans | $10.88 |
| Amerigroup | Medicare|All Plans | $11.09 |
| Great Plains | Medicare|All Plans | $11.09 |
| Medica | Commercial|ACO | $20.18 |
| Medica | Commercial|CHI Health | $21.71 |
| Medica | Commercial|All Other Plans | $22.74 |
| AMPS | Commercial|All Plans | $23.44 |
| United | Medicaid|Community Plan | $51.24 |
| Centene | Medicaid|NE Total Care | $51.76 |
| Greater Omaha Packing | Commercial|Narrow Network | $106 |
| Millard Public Schools | Commercial|Narrow Network | $106 |
| One World | Commercial|Narrow Network | $106 |
| Creighton University Employees | Commercial|All Plans | $120 |
| Greater Omaha Packing | Commercial|Broad Network | $122 |
| Millard Public Schools | Commercial|Broad Network | $122 |
| One World | Commercial|Broad Network | $122 |
| Timpte | Commercial|Broad Network | $122 |
| ELAP | Commercial|All Plans | $142 |
| United | Commercial|All Plans | $185 |
| Medica | Commercial|Open Access | $190 |
| Midlands Choice | Commercial|Premier | $190 |
| Midlands Choice | Commercial|Standard | $224 |
Inpatient
$149cash price (self-pay)
$244list price
$120–$227range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Creighton University Employees | Commercial|All Plans | $120 |
| United | Commercial|All Plans | $185 |
| Medica | Commercial|Open Access | $190 |
| Midlands Choice | Commercial|Premier | $190 |
| Midlands Choice | Commercial|Standard | $224 |
| MultiPlan PHCS | Commercial|All Plans | $227 |
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