CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Spotsylvania Regional Medical Center

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $296
Cash Discount Price: $1,056
vs. Medicare Baseline: 28.03x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Spotsylvania Regional Medical Center is $296. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,056. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 28.03x the Medicare baseline. Located in 4600 Spotsylvania Parkway, Fredericksburg, VA.

Cash / Self-Pay

$1,056

Average discount available for prompt cash payment at this facility.

Insurance Median

$296

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: $1,056 (10000%)

Insurance Median: $296 (2803%)

Cash: $1,056 (10000% of Medicare)

Ins. Median: $296 (2803% 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 2803% of the Medicare baseline (a markup of 2703%). 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
Humana	$10 - $11	95%
Aetna	$11	104%
Align Senior Care	$11	104%
Blue Cross Blue Shield	$11 - $55	104%
Cigna	$11 - $52	104%
Clear Spring Health Plan	$11	104%
Devoted	$11	104%
Evernorth Behavioral Health	$11	104%
Johns Hopkins	$11	104%
Sentara Health	$11	104%
United	$11 - $521	104%
United Behavioral Health	$11	104%
Virginia Premier Health	$11	104%
Bright Health	$23	218%
Lifeworks	$181 - $220	1714%
Virginia Health Network	$333 - $753	3153%
Kaiser	$562 - $684	5322%
Greenvbrier Sporting Club	$572 - $695	5417%
Multiplan	$676 - $823	6402%
Corvel	$686 - $834	6496%
Occunet Workers Comp	$762 - $927	7216%
4Most Health Nework	$857 - $1,043	8116%
Three Rivers Provider Network	$857 - $1,043	8116%

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 $1,056.
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 Spotsylvania Regional Medical Center 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.