CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Clarion Hospital

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $20
Cash Discount Price: $45
vs. Medicare Baseline: 1.89x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Clarion Hospital is $20. 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 1.89x the Medicare baseline. Located in One Hospital Drive, Clarion, PA.

Cash / Self-Pay

$45

Average discount available for prompt cash payment at this facility.

Insurance Median

$20

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: $20 (189%)

Cash: $45 (426% of Medicare)

Ins. Median: $20 (189% 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.

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
Highmark	$10 - $27	95%
Martin'S Point - Usfhp	$10 - $28	95%
Tricare	$10	95%
Aetna	$11 - $71	104%
Amerihealth	$11 - $13	104%
Cigna	$11 - $40	104%
Devoted Health Plan	$11 - $32	104%
Gateway	$11 - $30	104%
Geisinger	$11 - $12	104%
Highmark Community Blue	$11	104%
Medicare (plans)	$11	104%
Pa Health & Wellness	$11	104%
The Health Plan	$11 - $25	104%
UnitedHealthcare	$11	104%
American Health Plan	$12	114%
Jefferson Health Plan	$12	114%
Medicaid / KanCare	$12	114%
Upmc	$12 - $57	114%
Highmark - Ind.& Managed Care	$24 - $27	227%
Peak Health	$25 - $56	237%
Devon	$60	568%

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 $45.
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 Clarion Hospital 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.