Comprehensive metabolic panel at WellSpan Good Samaritan Hospital. CPT 80053.
What WellSpan Good Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$25.00cash price (self-pay)
$57.00list price
$10.56–$522range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue_Cross_BlueJourney_Medicare | All_Plans | $10.56 |
| Highmark_Medicare | All_Plans | $10.67 |
| Aetna_Advantra_Medicare | All_Plans | $10.88 |
| Aetna_Medicare | All_Plans | $10.88 |
| Geisinger_Gold_Medicare | All_Plans | $11.09 |
| Devoted_Medicare | All_Plans | $11.09 |
| United_Medicare | ISNP_DSNP_Plans | $11.09 |
| Amerihealth_Medicare | All_Plans | $11.14 |
| Highmark_Wholecare_Gateway_Medicare | All_Plans | $11.14 |
| UPMC_Medicare | UPMC_for_Life_Community_HealthChoices | $11.14 |
| UPMC_Medicare | UPMC_for_Life_Complete_Care | $11.14 |
| Jefferson_Health_Medicare_Advantage | All_Plans | $11.40 |
| PA_Health_&_Wellness_Medicare | All_Plans | $11.40 |
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $14.61 |
| Geisinger_Medicaid | All_Plans | $14.61 |
| Health_Partners_Medicaid | All_Other_Plans | $14.61 |
| PA_Health_&_Wellness_Medicaid | All_Plans | $14.61 |
| UPMC_Medicaid | All_Plans | $14.61 |
| Blue_Cross | Capital_Blue_Performance_PPO | $15.44 |
| Highmark | Higmark_Healthy_Kids | $16.37 |
| Amerihealth_Caritas_Medicaid | All_Plans | $16.60 |
| Health_Partners_Medicaid | Kidz_Partners | $17.42 |
| United_Medicaid | Community_Plan_For_Kids | $18.48 |
| WellSpan_Capital_Blue_Cross | All_Plans | $26.00 |
| United_Healthcare | All_Plans | $31.68 |
| Highmark | Choice_Blue_PPO | $31.94 |
| Highmark | Performance_Blue | $31.94 |
| Highmark | Blue_Cross_High_Performance_Network | $31.94 |
| Geisinger | All_Plans | $34.20 |
| UPMC | UPMC_For_Kids | $34.20 |
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