CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Adventist Health St Helena

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $12
Cash Discount Price: $47
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Adventist Health St Helena is $12. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $47. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 1.14x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$47

Average discount available for prompt cash payment at this facility.

Insurance Median

$12

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.56 (100%)

Cash / Self-Pay: $47 (445%)

Insurance Median: $12 (114%)

Cash: $47 (445% of Medicare)

Ins. Median: $12 (114% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $10.56 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Healthnet-All Plans	$1 - $65	9%
Blue Shield Behav Hlth	$6 - $277	57%
Blue Shield Epn-All Other Plans	$6 - $290	57%
Blue Shield Non-Epn	$6 - $286	57%
UnitedHealthcare	$6 - $393	57%
Phcs-All Plans	$7 - $339	66%
Western Growers-All Plans	$7 - $326	66%
Interplan-All Plans	$8 - $400	76%
Choicecare-All Plans	$9 - $431	85%
Beech Street-All Plans	$10 - $462	95%
Cigna	$10 - $493	95%
Kaiser-All Other Plans	$10 - $505	95%
Blue Shield Bh Mcr Adv	$11	104%
Blue Shield Mcr Adv	$11	104%
Galaxy Network-All Plans	$11 - $554	104%
Health Management Network-All Plans	$11 - $524	104%
Kaiser Mcr Adv	$11	104%
Three Rivers-All Plans	$11 - $554	104%
Tricare	$11	104%
Va Mcr - All Other Plans	$11	104%
Va Medi-Cal	$12	114%
Ah Employee Health Plan - All Plans	$19	180%
Aetna	$62	587%
Blue Cross Blue Shield	$92 - $122	871%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $47.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 80053.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health St Helena is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 80053.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.