CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Adventist Health and Rideout

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $44
Cash Discount Price: $16
vs. Medicare Baseline: 4.17x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Adventist Health and Rideout is $44. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 4.17x the Medicare baseline. Located in 726 4Th St, Marysville, CA.

Cash / Self-Pay

$16

Average discount available for prompt cash payment at this facility.

Insurance Median

$44

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: $16 (152%)

Insurance Median: $44 (417%)

Cash: $16 (152% of Medicare)

Ins. Median: $44 (417% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 417% of the Medicare baseline (a markup of 317%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Bc Mcal	$3	28%
Healthnet Mcal	$3 - $114	28%
Healthnet Comm-All Other Plans	$8 - $341	76%
Aetna	$9 - $403	85%
Blue Cross Blue Shield	$10 - $439	95%
Blue Shield Uc Care Members	$10 - $456	95%
Kaiser-All Other Plans	$10 - $433	95%
UnitedHealthcare	$10 - $495	95%
Cigna	$11 - $486	104%
First Health-All Plans	$11 - $499	104%
Interplan-All Plans	$11 - $513	104%
Kaiser Mcr Adv	$11	104%
Phcs-All Plans	$11 - $502	104%
Tricare	$11	104%
Blue Shield-All Other Plans	$12 - $542	114%
Kaiser Mcal	$12	114%
Medi-Cal	$12	114%
Multiplan-All Plans	$12 - $542	114%
Partnership Hp Mcal -All Plans	$12	114%
Ca Health And Wellness- All Plans	$13 - $15	123%
Celtic Mcaid-All Plans	$13 - $15	123%
Ah Employee Health Plan - All Plans	$19	180%

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 $16.
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 and Rideout 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.