CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Hillcrest Hospital Claremore

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $167
Cash Discount Price: $127
vs. Medicare Baseline: 15.81x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Hillcrest Hospital Claremore is $167. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $127. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 15.81x the Medicare baseline. Located in 1202 N Muskogee Place, Claremore, OK.

Cash / Self-Pay

$127

Average discount available for prompt cash payment at this facility.

Insurance Median

$167

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: $127 (1203%)

Insurance Median: $167 (1581%)

Cash: $127 (1203% of Medicare)

Ins. Median: $167 (1581% 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 1581% of the Medicare baseline (a markup of 1481%). 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
Black Lung [6055]	$106	1004%
Healthcare Highways [2210]	$106 - $167	1004%
Hooray Health [8000]	$106	1004%
Lucent Health [6000]	$106	1004%
Oncology Patient Assistance Programs [2295]	$106	1004%
Oscar Insurance Company [7005]	$106	1004%
Osma Health Network [2345]	$106	1004%
Healthscope Benefits [2290]	$127	1203%
UnitedHealthcare	$127 - $166	1203%
Resource One Administrators [2815]	$167	1581%
Web Tpa [2115]	$167	1581%
Beacon Health Options Behavioral Health [2890]	$182	1723%
The Kempton Group Administrators [2905]	$191	1809%
Pba [1775]	$211	1998%
Medica [2910]	$240	2273%
Employee Benefit Management Services [2445]	$310	2936%
Healthcost Solutions [2415]	$331	3134%
Healthfirst [2395]	$331	3134%
Hometown Health [2155]	$331	3134%
Mayo Clinic Health Solutions [2280]	$331	3134%
Planned Administrators Inc [2360]	$331	3134%
Trustmark [2030]	$331	3134%
Universal Fidelity [2085]	$331	3134%

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 $127.
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 Hillcrest Hospital Claremore 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.