Blood test, basic metabolic panel
Facility: Hiawatha Community Hospital
Billing Code: 80048 (CPT)
- CPT Billing Code: 80048
- Insurance Median: $65
- Cash Discount Price: $84
- vs. Medicare Baseline: 7.68x 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 768% of the Medicare baseline (a markup of 668%). 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 - $20 | 225% |
| Aetna | $31 - $68 | 366% |
| UnitedHealthcare | $31 - $72 | 366% |
| Humana | $31 | 366% |
| Ambetter / Centene | $37 | 437% |
| Centrus Health Direct - All Plans | $63 | 745% |
| Oscar - All Plans | $63 | 745% |
| Preferred Hlth - All Plans | $76 | 898% |
| Cigna | $80 | 946% |
| Wppa Providrs Care - All Plans | $80 | 946% |
| Midlands Choice - All Plans | $81 | 957% |
| Multiplan - All Plans | $81 | 957% |
| Healthy Blue Mcaid - All Plans | $84 | 993% |
Consumer Guidance & Cost Commentary
For the blood test, basic metabolic panel (CPT 80048) at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $84.00, which matches the facility's gross charge and the median cash rate. This cash price is significantly higher than the state average, as indicated by the 7.7% variance against the Medicare benchmark of $8.46. While commercial insurance plans like Aetna, UnitedHealthcare, and Humana negotiate rates ranging from $31 to $72, these negotiated amounts often exceed the cash price. For patients with high-deductible plans, paying the $84.00 cash rate directly may result in lower out-of-pocket costs compared to having insurance pay a higher negotiated rate while the patient remains responsible for their deductible.
Patients should verify if the facility offers "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. Although the data shows a median negotiated payment of $50.00 and a median negotiated rate of $65.00, these figures reflect insurance processing costs and administrative overhead rather than the actual service cost. To ensure you are not overcharged, request an itemized billing audit to review every line item and confirm that no services were bundled incorrectly or services not rendered were included. Always dispute any balance bills immediately and avoid signing consent waivers that waive your rights to No Surprises Act protections, ensuring you have the best possible financial outcome for your care.