Blood test, basic metabolic panel
Facility: Nmc Health
Billing Code: 80048 (CPT)
- CPT Billing Code: 80048
- Insurance Median: $57
- Cash Discount Price: $61
- vs. Medicare Baseline: 6.74x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 674% of the Medicare baseline (a markup of 574%). 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $20 | 236% |
| Aetna | $27 - $72 | 319% |
| Wppa | $48 | 567% |
| Occunet | $52 | 615% |
| Medincrease Health Plan | $57 | 674% |
| Samaritan Ministries International | $57 | 674% |
| Prime Health Services | $65 | 768% |
| UnitedHealthcare | $78 | 922% |
| Cigna | $83 | 981% |
Consumer Guidance & Cost Commentary
For this basic metabolic panel blood test at Nmc Health in Newton, KS, the cash price of $61.00 is notably lower than the facility's gross charge of $87.00. While the facility's negotiated rates with major insurers like Aetna and Blue Cross Blue Shield range from $20 to $72, the cash price often represents a more affordable option for patients with high-deductible plans or those without insurance. It is important to note that commercial negotiated rates frequently exceed cash prices due to administrative costs and contract structures, meaning paying out-of-pocket upfront can sometimes result in significant savings compared to what insurance will allow. Patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the standard insurance billing cycle and lower the final cost.
The facility's pricing is also contextualized by the Medicare benchmark, which serves as a scientifically validated baseline for healthcare costs. In this case, the Medicare amount of $8.46 is significantly lower than both the cash price and the negotiated rates, highlighting the typical markup found in commercial billing. Although the data does not provide specific state or county average comparisons for this specific CPT code, understanding that Medicare rates represent the "true cost" of delivery helps patients evaluate whether the facility's rates are reasonable. To ensure you are not overcharged, we recommend requesting a full itemized bill that breaks down every CPT code and unit cost, as summary bills often obscure individual charges. If you receive a balance bill from an out-of-network provider at this in-network facility, you may be protected under the No Surprises Act, which bans balance billing for emergency and non-emergency services at