CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Adventist Health Castle

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $82
Cash Discount Price: $68
vs. Medicare Baseline: 7.77x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Adventist Health Castle is $82. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $68. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 7.77x the Medicare baseline. Located in 640 Ulukahiki St, Kailua, HI.

Cash / Self-Pay

$68

Average discount available for prompt cash payment at this facility.

Insurance Median

$82

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: $68 (644%)

Insurance Median: $82 (777%)

Cash: $68 (644% of Medicare)

Ins. Median: $82 (777% 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 777% of the Medicare baseline (a markup of 677%). 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
Devoted Hlth Mcr Adv - All Plans	$11	104%
Kfh Mcr Adv	$11	104%
Medicare (plans)	$11	104%
Ohana Health Plan - All Plans	$11	104%
Pacific Admin Ppo - All Plans	$13 - $32	123%
Uni Health Alliance - All Plans	$13 - $32	123%
UnitedHealthcare	$15	142%
Multiplan Hmn - All Plans	$16	152%
Hmsa Hmo	$23	218%
Hmsa Ppo - All Other Plans	$23	218%
Alohacare Quest Mcaid - All Other Plans	$30 - $75	284%
Hwmg/Hmaa - All Plans	$88 - $222	833%
Health Alliance - All Plans	$96 - $242	909%
Mdx Hawaii Ppo - All Plans	$96 - $241	909%
Kfh - All Other Plans	$102 - $257	966%
First Health Ppo - All Plans	$113 - $284	1070%
Medicaid / KanCare	$120 - $302	1136%
State Of Hi Nonprofit - All Plans	$210 - $528	1989%

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 $68.
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 Castle 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.