CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Avita Ontario

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $49
Cash Discount Price: $376
vs. Medicare Baseline: 4.64x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Avita Ontario is $49. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $376. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 4.64x the Medicare baseline. Located in 715 Richland Mall, Ontario, OH.

Cash / Self-Pay

$376

Average discount available for prompt cash payment at this facility.

Insurance Median

$49

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: $376 (3561%)

Insurance Median: $49 (464%)

Cash: $376 (3561% of Medicare)

Ins. Median: $49 (464% 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 464% of the Medicare baseline (a markup of 364%). 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	$33 - $3,588	313%
Blue Cross Blue Shield	$33 - $3,518	313%
Buckeye	$33 - $3,518	313%
Caresource	$33	313%
Humana	$33 - $3,518	313%
Medicaid / KanCare	$33	313%
Medicare (plans)	$33 - $3,518	313%
Molina	$33 - $5,629	313%
Mount_Carmel	$33 - $3,518	313%
Ohiorise	$33	313%
United_Healthcare	$33 - $376	313%
Medical_Mutual	$34 - $5,539	322%
Amerihealth	$35	331%
Cigna	$344	3258%

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 $376.
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 Avita Ontario 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.