CMS Price Transparency Data
Blood test, comprehensive metabolic panel
Facility: Saint Alphonsus Medical Center Ontario
Billing Code: 80053 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 80053
- Insurance Median: $21
- Cash Discount Price: $45
- vs. Medicare Baseline: 1.99x Medicare
The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Saint Alphonsus Medical Center Ontario is $21. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $45. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 1.99x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.
Cash / Self-Pay
$45
Average discount available for prompt cash payment at this facility.
Insurance Median
$21
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: $45 (426%)
Insurance Median: $21 (199%)
Cash: $45 (426% of Medicare)
Ins. Median: $21 (199% 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.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $7 - $21 | 66% |
| Blue Cross Blue Shield | $10 - $59 | 95% |
| Medicare (plans) | $10 - $11 | 95% |
| UnitedHealthcare | $10 - $66 | 95% |
| Aetna | $11 - $65 | 104% |
| American Health Advantage Of Idaho | $11 | 104% |
| Healthnet | $11 | 104% |
| Blue Benefit Administrators Of Massachusetts | $18 | 170% |
| Blue Care Network | $18 | 170% |
| Blue Distinction Transplant | $18 | 170% |
| Blue Shield - Ca | $18 | 170% |
| Blue Shield - Id (Regence) | $18 | 170% |
| Blue Shield - Ny Highmark Northeastern | $18 | 170% |
| Blue Shield - Ny Highmark Western | $18 | 170% |
| Blue Shield - Pa (Highmark) | $18 | 170% |
| Blue Shield - Wa (Regence) | $18 | 170% |
| Healthcare Management Admin | $18 | 170% |
| Ada County Jail Inmate Ins | $21 | 199% |
| Ambetter / Centene | $21 | 199% |
| Amish Mennonite | $21 | 199% |
| Bcccp-Michigan | $21 | 199% |
| Bccp | $21 | 199% |
| Bmc Healthnet | $21 | 199% |
| Breast Grant-Connecticut | $21 | 199% |
| California Health And Wellness | $21 | 199% |
| Cardinal Innovations Lme | $21 | 199% |
| Care Oregon Ohp | $21 | 199% |
| Cencal Health Plan | $21 | 199% |
| Cenpatico | $21 | 199% |
| Centurion Of Idaho | $21 | 199% |
| Chhuny | $21 | 199% |
| Childrens Comm Health Plan | $21 | 199% |
| Childrens Medical Services Title 19 | $21 | 199% |
| Cigna | $21 - $65 | 199% |
| Community Benefit Health | $21 | 199% |
| Community Care Behavorial Health | $21 | 199% |
| Community Health Choice | $21 | 199% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $21 | 199% |
| Dean Wi Badgercare | $21 | 199% |
| Delaware First Health | $21 | 199% |
| Delta Dental Nj | $21 | 199% |
| Dph Tb Program | $21 | 199% |
| Dscc | $21 | 199% |
| Eastpointe Lme | $21 | 199% |
| Family Health Network | $21 | 199% |
| Freedom First Healthcare | $21 | 199% |
| Ghc Scw Wi Badgercare | $21 | 199% |
| Harbor Health | $21 | 199% |
| Health Safety Net | $21 | 199% |
| Healthy Blue Ne | $21 | 199% |
| Hennepin Health | $21 | 199% |
| Humana | $21 - $61 | 199% |
| Id County Ada | $21 | 199% |
| Id County Canyon | $21 | 199% |
| Id County Cat Fund | $21 | 199% |
| Id County Payette | $21 | 199% |
| Idaho Womens Health Check | $21 | 199% |
| Indiana Breast Cervical Cancer | $21 | 199% |
| Inland Empire Health Plan | $21 | 199% |
| Intercommunity Health Ohp | $21 | 199% |
| Iowa Total Care | $21 | 199% |
| Jai Medical System | $21 | 199% |
| Kern Family Health Plan | $21 | 199% |
| Keystone First | $21 | 199% |
| Keystone First Chip | $21 | 199% |
| La Care Health Plan | $21 | 199% |
| Lakeland Care Inc | $21 | 199% |
| Managed Health Services - Indiana | $21 | 199% |
| Maryland Breast & Cervical Program | $21 | 199% |
| Maryland Healthy Smiles - Scion Dental | $21 | 199% |
| Maryland Physicians Care | $21 | 199% |
| Massachusetts Behavioral Health Partnership | $21 | 199% |
| Mdwise | $21 | 199% |
| Medi-Cal | $21 | 199% |
| Medi-Cal Healthnet | $21 | 199% |
| Medstar Dc Healthy Family | $21 | 199% |
| Medstar Md Health Choice | $21 | 199% |
| Mo Home State Health Plan | $21 | 199% |
| Moda Health | $21 - $67 | 199% |
| Molina Centennial Care | $21 | 199% |
| Nascentia Health Options | $21 | 199% |
| Nebraska Total Care | $21 | 199% |
| New York Cancer Services Program | $21 | 199% |
| Nextlevel Health | $21 | 199% |
| Oregon Screenwise | $21 | 199% |
| Pace Of Southwest Michigan | $21 | 199% |
| Paramount Advantage | $21 | 199% |
| Parkland Community Health Plan | $21 | 199% |
| Partners Behavioral Lme | $21 | 199% |
| Peach State Healthplan | $21 | 199% |
| Presbyterian Centennial Care | $21 | 199% |
| Prestige Health Choice | $21 | 199% |
| Priority Partners | $21 | 199% |
| Rx 340B Pass Along | $21 | 199% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $21 | 199% |
| Rx Medi-Cal | $21 | 199% |
| Rx Meridian Rx | $21 | 199% |
| Sandhills Center Lme | $21 | 199% |
| Screening For Life | $21 | 199% |
| Sunshine State Health Plan | $21 | 199% |
| Superior Health | $21 | 199% |
| Tenncare | $21 | 199% |
| Texas Children'S Health Plan | $21 | 199% |
| Trillium Community Ohp | $21 | 199% |
| Tufts Health Public Plans | $21 | 199% |
| Vaya Health Lme | $21 | 199% |
| Wellsense Health Plan | $21 | 199% |
| Wi Womens Wellness | $21 | 199% |
| Webtpa | $28 - $62 | 265% |
| Selecthealth | $40 - $62 | 379% |
| Mountain Health Co-Op | $41 | 388% |
| Pacificsource Health Plans | $41 - $65 | 388% |
| Allegiance | $52 | 492% |
| Correctional Health Partners | $54 | 511% |
| Columbia Health Network | $55 | 521% |
| Allied National Global Care | $62 | 587% |
| Asrm - Reliance Standard Life Insurance | $62 | 587% |
| Christian Care Ministry | $62 | 587% |
| Dean Health | $62 | 587% |
| Fallon Health | $62 | 587% |
| Family Life Insurance Company | $62 | 587% |
| First Choice Health | $62 | 587% |
| Ghc Scw | $62 | 587% |
| International Benefit Administrators | $62 | 587% |
| Lifetime Benefit Solutions | $62 | 587% |
| Manhattan Life | $62 | 587% |
| Pai | $62 | 587% |
| Pan-American Life | $62 | 587% |
| Paramount Hmo | $62 | 587% |
| Phcs | $62 | 587% |
| Trinity Health Share | $62 | 587% |
| Lifewise | $64 | 606% |
| Allied Benefit Systems | $65 | 616% |
| Ameriben | $65 | 616% |
| Asr Health Benefits | $65 | 616% |
| Christian Brother Services | $65 | 616% |
| Geha | $65 - $66 | 616% |
| Healthez | $65 | 616% |
| Luminare Health (Detroit) | $65 | 616% |
| Priority Health | $65 | 616% |
| Rural Carrier Health Benefit Plan | $65 | 616% |
| First Health | $66 | 625% |
| Medi Share | $66 | 625% |
| Providence | $66 | 625% |