CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: UMass Memorial Health - Harrington Hospital

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $120
Cash Discount Price: $177
vs. Medicare Baseline: 11.36x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at UMass Memorial Health - Harrington Hospital is $120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $177. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 11.36x the Medicare baseline. Located in 100 South Street, Southbridge, MA.

Cash / Self-Pay

$177

Average discount available for prompt cash payment at this facility.

Insurance Median

$120

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: $177 (1676%)

Insurance Median: $120 (1136%)

Cash: $177 (1676% of Medicare)

Ins. Median: $120 (1136% 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 1136% of the Medicare baseline (a markup of 1036%). 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
Aetna	$11 - $178	104%
Blue Cross Blue Shield	$11 - $27	104%
Cigna	$11 - $127	104%
Commonwealth Care Alliance [10103]	$11	104%
Fallon Mcr Supp [20202]	$11	104%
Fallon Mcr [10105]	$11	104%
Institution [10406]	$11	104%
Medicaid / KanCare	$11	104%
Mgb Mcr [10124]	$11	104%
Senior Whole Health [10110]	$11	104%
Tufts Mcr [10112]	$11	104%
Tufts Us Family [11203]	$11	104%
UnitedHealthcare	$11 - $178	104%
Champva [11001]	$13	123%
Workers Compensation [20501]	$15	142%
Tufts Connectorcare [10507]	$18	170%
Wellpoint [11112]	$28	265%
Harvard Pilgrim [10701]	$39 - $47	369%
Fallon Connectorcare [10503]	$104	985%
Hne [11108]	$114 - $116	1080%
Tufts [11201]	$124 - $127	1174%
First Health Network [11120]	$131 - $134	1241%
Evernorth Behavioral Health [27]	$140 - $142	1326%
Connecticare [11105]	$175 - $178	1657%
Fallon Carelon Hlth [28]	$175 - $178	1657%
Fallon Mcaid Carelon Hlth [29]	$175 - $178	1657%
Grants [20507]	$175 - $178	1657%
Masshealth Mcd Mbhp [38]	$175 - $178	1657%
Wellsense Mcaid Carelon Hlth [21]	$175 - $178	1657%
Hsno/Free Care [10801]	$681	6449%

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 $177.
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 UMass Memorial Health - Harrington Hospital 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.