CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: Othello Community Hospital

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $147
Cash Discount Price: $138
vs. Medicare Baseline: 13.92x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at Othello Community Hospital is $147. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $138. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 13.92x the Medicare baseline. Located in 315 North 14Th Avenue, Othello, WA.

Cash / Self-Pay

$138

Average discount available for prompt cash payment at this facility.

Insurance Median

$147

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: $138 (1307%)

Insurance Median: $147 (1392%)

Cash: $138 (1307% of Medicare)

Ins. Median: $147 (1392% 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 1392% of the Medicare baseline (a markup of 1292%). 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
Ambetter / Centene	$78 - $79	739%
Amerigroup Mcaid	$78	739%
Chp Mcaid	$78	739%
Cocare - All Plans	$78	739%
Gau - All Plans	$78	739%
Kaiser - All Plans	$78	739%
Molina Mcaid	$78	739%
UnitedHealthcare	$78 - $184	739%
Chp - All Other Plans	$79	748%
Molina - All Other Plans	$79	748%
Medicare (plans)	$92	871%
Tricare	$119	1127%
Triwest - All Plans	$119	1127%
Asuris - All Plans	$147	1392%
Commercial Other - All Plans	$147	1392%
Hma - All Plans	$147	1392%
Hmso - All Plans	$147	1392%
Tpsc - All Plans	$147	1392%
Travelers - All Plans	$147	1392%
Veterans Admin - All Plans	$147	1392%
Blue Cross Blue Shield	$154	1458%
Cigna	$164	1553%
First Choice - All Plans	$165	1563%
Aetna	$173	1638%
Chp Mcr Adv	$184	1742%
Health Alliance Mcr Adv - All Plans	$184	1742%
Humana	$184	1742%
Molina Mcare	$184	1742%
Wellcare Mcr Adv - All Plans	$184	1742%

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 $138.
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 Othello Community 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.