CMS Price Transparency Data
Blood test, basic metabolic panel
Facility: Saint Joseph Regional Medical Center - Plymouth
Billing Code: 80048 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 80048
- Insurance Median: $35
- Cash Discount Price: $313
- vs. Medicare Baseline: 4.14x Medicare
The contracted insurance negotiated median rate for a Blood test, basic metabolic panel at Saint Joseph Regional Medical Center - Plymouth is $35. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $313. Compared to the federal Medicare reimbursement reference rate of $8.46, this hospital’s rate is 4.14x the Medicare baseline. Located in 1915 Lake Ave, Plymouth, IN.
Cash / Self-Pay
$313
Average discount available for prompt cash payment at this facility.
Insurance Median
$35
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$8.46
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $8.46 (100%)
Cash / Self-Pay: $313 (3700%)
Insurance Median: $35 (414%)
Cash: $313 (3700% of Medicare)
Ins. Median: $35 (414% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $8.46 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 414% of the Medicare baseline (a markup of 314%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 |
|---|---|---|
| Aetna | $5 - $112 | 59% |
| Blue Cross Blue Shield | $5 - $69 | 59% |
| Medicaid / KanCare | $5 - $35 | 59% |
| UnitedHealthcare | $5 - $146 | 59% |
| Managed Health Services - Indiana | $8 - $35 | 95% |
| Mdwise | $8 - $35 | 95% |
| Medicare (plans) | $8 - $35 | 95% |
| Meridian Complete | $8 - $35 | 95% |
| Pace-Trinity Health | $8 - $35 | 95% |
| County Coroner | $9 - $36 | 106% |
| Provider Partners Health Plan Of Indiana | $9 - $38 | 106% |
| Auxiant | $13 - $190 | 154% |
| Caresource | $13 - $54 | 154% |
| Physicians Health Plan Northern Indiana Health Insurance | $13 - $104 | 154% |
| St Joseph County Hlth Dpt | $13 - $52 | 154% |
| Siho Insurance Services | $14 - $55 | 165% |
| Key Benefit Administrator | $15 - $161 | 177% |
| Allied Benefit Systems | $16 - $149 | 189% |
| Blue Benefit Administrators Of Massachusetts | $17 - $69 | 201% |
| Blue Care Network | $17 - $69 | 201% |
| Blue Distinction Transplant | $17 - $69 | 201% |
| Blue Shield - Ca | $17 - $69 | 201% |
| Blue Shield - Id (Regence) | $17 - $69 | 201% |
| Blue Shield - Ny Highmark Northeastern | $17 - $69 | 201% |
| Blue Shield - Ny Highmark Western | $17 - $69 | 201% |
| Blue Shield - Pa (Highmark) | $17 - $69 | 201% |
| Blue Shield - Wa (Regence) | $17 - $69 | 201% |
| Custom Design Benefits | $18 - $74 | 213% |
| Plain Church Group | $62 | 733% |
| Asr Health Benefits | $112 | 1324% |
| Christian Brother Services | $112 | 1324% |
| Employee Benefit Management | $112 | 1324% |
| Medical Mutual | $112 | 1324% |
| Meritain | $112 | 1324% |
| Preferred One | $112 | 1324% |
| Rural Carrier Health Benefit Plan | $112 | 1324% |
| Webtpa | $112 | 1324% |
| Notre Dame Athletic Association | $126 | 1489% |
| Wc Notre Dame | $126 | 1489% |
| Luminare Health (Detroit) | $131 - $137 | 1548% |
| Ameriben | $137 | 1619% |
| Geha | $146 | 1726% |
| Healthscope | $146 | 1726% |
| Student Insurance Cma | $146 | 1726% |
| Encore Health | $161 | 1903% |
| Indiana Criminal Justice Inst | $161 | 1903% |
| Western & Southern Financial Group | $161 | 1903% |
| Cigna | $165 | 1950% |
| Group Administrators | $165 | 1950% |
| Health Partners | $165 | 1950% |
| Mvp | $165 | 1950% |
| Prairie States | $165 | 1950% |
| Priority Health | $165 | 1950% |
| Professional Benefit Administrators | $165 | 1950% |
| Sagamore Health Network | $165 - $176 | 1950% |
| Sisco Benefits | $165 | 1950% |
| Unified Group Services | $165 | 1950% |
| Goshen Preferred Network | $176 - $197 | 2080% |
| Signature Care | $190 | 2246% |
| Allied National Global Care | $206 | 2435% |
| Asrm - Reliance Standard Life Insurance | $206 | 2435% |
| Avmed Health Plan | $206 | 2435% |
| Christian Care Ministry | $206 | 2435% |
| Dean Health | $206 | 2435% |
| Fallon Health | $206 | 2435% |
| Family Life Insurance Company | $206 | 2435% |
| Freedom Life Insurance Company | $206 | 2435% |
| Ghc Scw | $206 | 2435% |
| International Benefit Administrators | $206 | 2435% |
| Lifetime Benefit Solutions | $206 | 2435% |
| Manhattan Life | $206 | 2435% |
| Medi Share | $206 | 2435% |
| Multiplan | $206 | 2435% |
| Pai | $206 | 2435% |
| Pan-American Life | $206 | 2435% |
| Paramount Hmo | $206 | 2435% |
| Phcs | $206 | 2435% |
| Philadelphia American Life Insurance | $206 | 2435% |
| Trinity Health Share | $206 | 2435% |
| Bankers Life Casualty | $229 | 2707% |
| Bureau Of Disability | $229 | 2707% |
| Wc Align Network | $229 | 2707% |