Blood test, basic metabolic panel
Facility: Holton Community Hospital
Billing Code: 80048 (CPT)
- CPT Billing Code: 80048
- Insurance Median: $61
- Cash Discount Price: $66
- vs. Medicare Baseline: 7.21x 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 721% of the Medicare baseline (a markup of 621%). 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 | $19 | 225% |
| Aetna | $33 - $114 | 390% |
| UnitedHealthcare | $33 - $114 | 390% |
| Humana | $34 - $61 | 402% |
| Kansas Superior Select - All Plans | $34 - $62 | 402% |
| Preferred Health Freedom | $52 - $95 | 615% |
| Preferred Health Fn Select - All Other Plans | $52 - $95 | 615% |
| Preferred Health Professionals | $52 - $95 | 615% |
| Wppa Providers - All Plans | $60 - $108 | 709% |
| Medicaid / KanCare | $63 - $114 | 745% |
Consumer Guidance & Cost Commentary
For the blood test, basic metabolic panel (CPT 80048) at Holton Community Hospital, the facility's cash median price is $66.00, which is lower than the negotiated rates paid by most major payers. While the facility's cash rate is $66.00, the median negotiated amount across all payers is $61.00, and the highest negotiated rate recorded is $114.00. This data indicates that for patients with high-deductible plans or those without insurance, paying the cash price of $66.00 may be more cost-effective than relying on insurance, as many commercial payers negotiate rates that exceed the cash price. Additionally, patients should inquire about self-pay or prompt-pay discounts, which can further reduce the final amount owed.
When comparing this facility's pricing to broader benchmarks, the Medicare amount for this service is $8.46, and the facility's cash rate is significantly higher, reflecting standard commercial pricing structures. The facility is a Critical Access Hospital in Holton, KS, and while specific county or state average data was not provided in the source material, the wide variance in negotiated rates—from $19.00 for Blue Cross Blue Shield to $114.00 for Aetna and UnitedHealthcare—highlights the importance of verifying your specific plan's allowed amount before scheduling. To ensure you are not subject to balance billing or unexpected charges, patients should request an itemized bill to review all CPT codes and confirm that no out-of-network ancillary services were billed separately.