Comprehensive metabolic panel at Intermountain Health Good Samaritan Medical Center. CPT 80053.
What Intermountain Health Good Samaritan Medical Center publishes for this service, straight from its standard-charges file, last updated March 22, 2026.
Outpatient / ER
—cash price (self-pay)
$319list price
$6.86–$286range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Cigna | Cigna Co Public Option | $44.06 |
| Cigna | Cigna Connect Exchange | $44.06 |
| Cigna | Cigna Surefit | $44.06 |
| BCBS/Anthem | BCBS Co Federal | $72.93 |
| BCBS/Anthem | BCBS Co HMO | $72.93 |
| BCBS/Anthem | BCBS Co PPO | $72.93 |
| United Healthcare | Selectcolorado | $74.74 |
| Allegiance | Cigna Sclhs Employees | $79.84 |
| Cigna Scl Employees | Cigna Sclhs Cdhp | $79.84 |
| Cigna | Cigna HMO | $94.85 |
| Cigna | Cigna Indemnity | $94.85 |
| Cigna | Cigna Local Plus | $94.85 |
| Cigna | Cigna Other | $94.85 |
| Cigna | Cigna POS/Qpos | $94.85 |
| Cigna | Cigna PPO | $94.85 |
| Cigna | Eighth Dist Elect Ben Pln | $94.85 |
| Cigna | Health-Partners | $94.85 |
| Geha | Geha | $97.89 |
| Geha | Geha Mcr Supplemental | $97.89 |
| United Healthcare | All Savers Alternative Funding | $97.89 |
| United Healthcare | Golden Rule Ins | $97.89 |
| United Healthcare | Healthscope | $97.89 |
| United Healthcare | Medica | $97.89 |
| United Healthcare | Surest | $97.89 |
| United Healthcare | UHC Charter/Navigate | $97.89 |
| United Healthcare | UHC Exchange Plan | $97.89 |
| United Healthcare | Umr-United Med Resources | $97.89 |
| United Healthcare | United Healthcare | $97.89 |
| Aetna | Aetna Colorado Preferred | $119 |
| Aetna | Aetna HMO/EPO | $127 |
Inpatient
—cash price (self-pay)
$319list price
$94.21–$319range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $94.21 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $135 |
| Kaiser Perm HMO | Kaiser Out Of State | $135 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $135 |
| Kaiser Self Funded | Kaiser Self Funded | $135 |
| Kaiser Perm PPO/POS | Kaiser Perm PPO/POS | $139 |
| Private Hlthcare Sys | Phcs Other | $240 |
| Private Hlthcare Sys | Phcs PPO | $240 |
| BCBS/Anthem | BCBS Co Indemnity | $269 |
| Multiplan Inc | Multiplan Inc Other | $271 |
| Multiplan Inc | Multiplan Inc PPO | $271 |
| Aetna | Aetna Nap | $286 |
| Cigna | Cigna HMO | $319 |
| Cigna | Cigna Indemnity | $319 |
| Cigna | Cigna Local Plus | $319 |
| Cigna | Cigna Other | $319 |
| Cigna | Cigna POS/Qpos | $319 |
| Cigna | Cigna PPO | $319 |
| Cigna | Eighth Dist Elect Ben Pln | $319 |
| Cigna | Health-Partners | $319 |
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All common services at Intermountain Health Good Samaritan Medical Center