CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Prosser Memorial Hospital

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $199
Cash Discount Price: $137
vs. Medicare Baseline: 18.84x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Prosser Memorial Hospital is $199. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $137. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 18.84x the Medicare baseline. Located in 723 Memorial Street, Prosser, WA.

Cash / Self-Pay

$137

Average discount available for prompt cash payment at this facility.

Insurance Median

$199

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: $137 (1297%)

Insurance Median: $199 (1884%)

Cash: $137 (1297% of Medicare)

Ins. Median: $199 (1884% 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 1884% of the Medicare baseline (a markup of 1784%). 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
UnitedHealthcare	$18 - $101	170%
Kaiser Permanente	$50 - $227	473%
Community Health Plan Of Washington	$53 - $101	502%
Coordinated Care	$53 - $101	502%
Amerigroup	$56 - $107	530%
Molina	$56 - $101	530%
Health Alliance Northwest	$62	587%
Wellcare	$62	587%
Humana	$63 - $212	597%
Aetna	$75 - $212	710%
Ambetter / Centene	$174 - $192	1648%
Asuris	$199 - $224	1884%
Health Management Adminstrators	$199 - $224	1884%
Premera	$199	1884%
Regence	$199 - $224	1884%
Cigna	$204	1932%
First Choice	$212	2008%
Multiplan	$212 - $224	2008%

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 $137.
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 Prosser Memorial 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.