CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Adventist Health Tillamook

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $71
Cash Discount Price: $53
vs. Medicare Baseline: 6.72x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Adventist Health Tillamook is $71. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $53. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 6.72x the Medicare baseline. Located in 1000 Third Street, Tillamook, OR.

Cash / Self-Pay

$53

Average discount available for prompt cash payment at this facility.

Insurance Median

$71

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: $53 (502%)

Insurance Median: $71 (672%)

Cash: $53 (502% of Medicare)

Ins. Median: $71 (672% 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 672% of the Medicare baseline (a markup of 572%). 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
Blue Cross Blue Shield	$21 - $130	199%
Hvhs Mcare - All Plans	$21 - $71	199%
Medicare (plans)	$21 - $70	199%
Moda Health Plan - All Plans	$21 - $70	199%
Sterling Life - All Plans	$22 - $73	208%
Aetna	$23 - $140	218%
Devoted Health	$23 - $76	218%
Lifewise - All Plans	$41 - $135	388%
Ah Employee Health Plan - All Plans	$42 - $141	398%
First Choice Health- All Plans	$42 - $141	398%
Health Net - All Plans	$42 - $141	398%
Cigna	$43 - $142	407%
Pacificsource - All Plans	$43 - $144	407%
Phcs Preferred - All Plans	$43 - $142	407%
UnitedHealthcare	$43 - $142	407%
Ods Health Plan - All Other Plans	$44 - $146	417%
Providence Preferred - All Plans	$44 - $147	417%
Workers Comp	$45 - $150	426%

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 $53.
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 Adventist Health Tillamook 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.