CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Adena Regional Medical Center

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $37
Cash Discount Price: $29
vs. Medicare Baseline: 3.50x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Adena Regional Medical Center is $37. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $29. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 3.50x the Medicare baseline. Located in 272 Hospital Road, Chillicothe, OH.

Cash / Self-Pay

$29

Average discount available for prompt cash payment at this facility.

Insurance Median

$37

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: $29 (275%)

Insurance Median: $37 (350%)

Cash: $29 (275% of Medicare)

Ins. Median: $37 (350% 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 350% of the Medicare baseline (a markup of 250%). 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 - $77	104%
Buckeye Community Health Plan	$11	104%
Care Source	$11	104%
Gateway Health	$11	104%
Humana	$11 - $55	104%
Medical Mutual Of Ohio	$11 - $38	104%
Medigold	$11	104%
Molina	$11	104%
UnitedHealthcare	$11 - $26	104%
Molina Marketplace	$17	161%
Care Source Just4Me	$19	180%
Blue Cross Blue Shield	$26 - $37	246%
Sidecar Health	$29	275%
Cigna	$36	341%
Ohio Ppo Connect	$41	388%
The Health Plan	$41	388%
First Health	$45 - $76	426%
Ohio Health Choice	$46	436%
Healthsmart	$49	464%
Integrated Health Plan	$55	521%
Multiplan/Private Healthcare Systems	$55	521%
Three Rivers Network	$55	521%

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 $29.
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 Adena Regional Medical Center 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.