Blood test, basic metabolic panel
Facility: Nemaha Valley Community Hospital
Billing Code: 80048 (CPT)
- CPT Billing Code: 80048
- Insurance Median: $25
- Cash Discount Price: $44
- vs. Medicare Baseline: 2.96x 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 296% of the Medicare baseline (a markup of 196%). 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 |
|---|---|---|
| Va Ccn - All Plans | $4 | 47% |
| Humana | $22 | 260% |
| Aetna | $22 - $42 | 260% |
| Celtic Comm Exch - All Plans | $24 | 284% |
| Partners Direct Health - All Plans | $25 | 296% |
| Multiplan - All Plans | $44 | 520% |
| Health Partners - All Plans | $47 | 556% |
| Midlands Choice - All Plans | $47 | 556% |
Consumer Guidance & Cost Commentary
For the CPT code 80048, representing a basic metabolic panel at Nemaha Valley Community Hospital in Seneca, KS, the cash median price is $44.00, while the facility's median negotiated rate across payers is $25.00. This suggests that for patients with high-deductible plans, paying cash directly could result in lower out-of-pocket costs compared to using insurance, as the negotiated rate exceeds the cash price. However, patients should verify their specific plan's deductible status before scheduling, as insurance may still require them to pay the full negotiated amount if they have not yet met their annual deductible. Additionally, patients are encouraged to ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing administrative fees associated with insurance claims.
When evaluating the cost of this service, it is important to compare rates against the Medicare benchmark rather than the hospital's gross charge. The Medicare amount for this procedure is $8.46, which serves as the objective baseline for fair pricing; commercial negotiated rates typically range from 200% to 300% of this figure, while fair pricing is generally defined as 120% to 150%. In this case, the facility's negotiated rate of $25.00 represents a significant markup over the Medicare rate, highlighting the importance of understanding the difference between the hospital's list price and the actual reimbursement standards used by the federal government.