Comprehensive metabolic panel
What goes into a price?
Negotiated prices across insurers
Self pay or cash prices vary by facility when paying out of pocket without insurance benefits. The chart shows you how the lowest and highest amounts facilities charge for this service if you were paying without insurance benefits. If you're uninsured or not submitting a claim to insurance, you also have the right to a Good Faith Estimate under federal law. Contact the provider for a copy of your Good Faith Estimate or to better understand payment options available to you.
Procedures included in this package
This list includes the services and fees bundled into the Comprehensive metabolic panel Standard Service Package (SSP LA005). The final price for the procedure will depend on which services your provider ultimately performs, your insurance plan and your medical benefits.
| Code | Code Type | Description |
|---|---|---|
| HCPCS 80053 | Facility Fee | Comprehensive Metabolic Panel: Serum Albumin, Bilirubin, Calcium, Bicarb, Chloride, Creatinine, Glucose, Alk Phos, Potassium, Prot Total, Sodium, Alt, Ast, Bun |
| HCPCS 85025 | Facility Fee | Complete Automated Cbc, Differential Wbc Count |
| HCPCS 96374 | Facility Fee | Therapeutic IV Injection of Single Substance/Drug |
| Revenue Code 258 | Optional Fee | Pharmacy (Also see 063X, an extension of 250X) - IV solutions |
| Revenue Code 250 | Facility Fee | Pharmacy (Also see 063X, an extension of 250X) - General |
| HCPCS 81001 | Facility Fee | Automated Urinalysis with Dip Stick/Tablet Reagent and Microscopy |