CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Adventist Health Tulare

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $15
Cash Discount Price: $61
vs. Medicare Baseline: 1.42x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Adventist Health Tulare is $15. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $61. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 1.42x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$61

Average discount available for prompt cash payment at this facility.

Insurance Median

$15

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: $61 (578%)

Insurance Median: $15 (142%)

Cash: $61 (578% of Medicare)

Ins. Median: $15 (142% 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
Blue Cross Blue Shield	$3 - $108	28%
Blue Shield Epn	$4 - $366	38%
Blue Shield-All Other Plans	$6 - $506	57%
Cigna	$6 - $536	57%
Western Growers - All Plans	$6 - $532	57%
Network By Design-All Plans	$8 - $752	76%
Hs Interplan-All Plans	$9 - $775	85%
UnitedHealthcare	$9 - $838	85%
Blue Shield Mcare	$11	104%
Dignity Mcr Op Only - All Other Plans	$11	104%
Fhcn Pace Mcr Adv - All Plans	$11	104%
Medicare (plans)	$11	104%
Multiplan - All Plans	$11 - $983	104%
Prime Health - All Plans	$11	104%
Tricare	$11	104%
Medi-Cal	$12	114%
Ccipa Medi-Cal - All Plans	$13 - $16	123%
Dignity Mcal Op Only	$13	123%
Healthnet Medi-Cal	$13 - $16	123%
Independence Op Only - All Plans	$13	123%
Cal Forensic Med Grp - All Plans	$14	133%
Prison Hlthcre - All Plans	$14	133%
Bright Health - All Plans	$15	142%
Ah Employee Health Plan - All Plans	$19	180%
Incentive Hlth - All Plans	$19	180%
Healthnet Hmo/Ppo - All Other Plans	$28	265%
Aetna	$91	862%

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 $61.
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 Tulare 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.