Blood test, basic metabolic panel
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 80048 (CPT)
- CPT Billing Code: 80048
- Insurance Median: $14
- Cash Discount Price: $140
- vs. Medicare Baseline: 1.65x 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.
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 |
|---|---|---|
| United Medical Resources Contracted [320454] | $7 - $23 | 83% |
| Aetna | $7 - $8 | 83% |
| UnitedHealthcare | $7 - $200 | 83% |
| First Health Contracted [320128] | $7 | 83% |
| Medicare (plans) | $8 | 95% |
| Cross Timbers Hospice [20098] | $8 | 95% |
| Cherokee Nation Health Serv Contracted [320066] | $8 | 95% |
| Mercy Hospice Okc [20252] | $8 | 95% |
| Kindful Hospice [20434] | $8 | 95% |
| Dept Of Veteran Affairs Contracted [320106] | $8 | 95% |
| Halo Hcr Inc Hospice Contracted [320432] | $8 | 95% |
| Mercy Mgd Behavioral Health Contracted [320259] | $8 | 95% |
| Humana | $8 | 95% |
| Qual Choice Contracted [320325] | $8 | 95% |
| Blue Cross Blue Shield | $8 - $14 | 95% |
| Pace Of The Ozarks Contracted [320518] | $8 | 95% |
| Globalhealth Contracted [320145] | $8 | 95% |
| Cigna | $8 - $48 | 95% |
| Medicaid / KanCare | $8 - $12 | 95% |
| Kindful Hospice Contracted [320434] | $8 | 95% |
| Medica Contracted [320239] | $8 | 95% |
| Tricare | $8 | 95% |
| Medical Associates Health Contracted [320444] | $8 | 95% |
| Halo Hcr Inc Hospice [20432] | $8 | 95% |
| Elara Caring Aspire Hospice [20433] | $8 | 95% |
| Provider Partners Health Plans Contracted [320450] | $9 | 106% |
| Centivo Contracted [320505] | $14 | 165% |
| Providrs Care Network Contracted [320484] | $16 | 189% |
| Healthscope Contracted [320182] | $23 - $162 | 272% |
| Point C Contracted [320238] | $23 - $162 | 272% |
| Insurance System Inc Contracted [320465] | $23 | 272% |
| Health Systems Inc Contracted [320174] | $23 | 272% |
| Benefit Management Contracted [320052] | $23 | 272% |
| Mercy Benefit Admin Contracted [320251] | $52 - $151 | 615% |
| Show-Me Health Administrators Contracted [320483] | $52 | 615% |
| Yuzu Health Contracted [320521] | $151 | 1785% |
| Ebms Contracted [320493] | $151 | 1785% |
| American Healthcare Alliance Contracted [320020] | $151 | 1785% |
| Edison Health Solutions Contracted [320502] | $151 | 1785% |
| Aither Health Contracted [320449] | $151 | 1785% |
| Reflect Health Contracted [320492] | $151 | 1785% |
| Imagine 360 Contracted [320494] | $151 | 1785% |
| Auxiant Contracted [320462] | $151 - $162 | 1785% |
| Preferred Health Plan Contracted [320522] | $162 | 1915% |
| Federal Medical Center Contracted [320127] | $162 | 1915% |
| Healthlink Contracted [320179] | $162 | 1915% |
| Compcare Of The Ozarks Contracted [320437] | $171 | 2021% |
| Workers Comp [20426] | $173 | 2045% |
| Private Health Care Systems Contracted [320320] | $200 | 2364% |
| Multiplan Contracted [320270] | $205 | 2423% |
| Multiplan [20270] | $205 | 2423% |
Consumer Guidance & Cost Commentary
For the CPT code 80048, representing a basic metabolic panel blood test, Mercy Specialty Hospital Southeast Kansas lists a gross charge of $216.00. While the facility's cash median price is $140.00, commercial insurance negotiated rates vary significantly across payers, ranging from as low as $7.00 to as high as $205.00. It is important to note that these negotiated rates often exceed the cash price due to administrative costs and contract structures; for patients with high-deductible plans, paying the cash price of $140.00 upfront may result in lower out-of-pocket costs compared to using insurance, which could trigger a higher allowed amount once the deductible is met. Additionally, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these can further reduce the final bill.
The facility's pricing is evaluated against the Medicare benchmark of $8.46, which serves as the objective baseline for healthcare costs. The reported "vs_medicare" ratio of 1.7 indicates that the facility's rates are 1.7 times the Medicare amount, a standard metric for assessing markup transparency. While specific county or state average data was not provided in the source information, the wide variance in negotiated rates among the 51 payers listed—from $7.00 for some plans to $162.00 for others—highlights the importance of checking individual plan details. Patients are advised to request an itemized bill to ensure no errors exist and to confirm that any charges align with the negotiated rates or cash prices discussed prior to service.