Blood test, basic metabolic panel
Facility: Decatur Health
Billing Code: 80048 (CPT)
- CPT Billing Code: 80048
- Insurance Median: $28
- Cash Discount Price: $33
- vs. Medicare Baseline: 3.31x 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 331% of the Medicare baseline (a markup of 231%). 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 |
|---|---|---|
| Humana | $22 | 260% |
| Wppa/Providrs Care- All Plans | $22 | 260% |
| UnitedHealthcare | $22 - $28 | 260% |
| Blue Cross Blue Shield | $25 | 296% |
| Midlands Choice- All Plans | $33 | 390% |
| Aetna | $33 - $36 | 390% |
| Medicaid / KanCare | $37 | 437% |
Consumer Guidance & Cost Commentary
For this basic metabolic panel test at Decatur Health in Oberlin, Kansas, the facility's cash median price of $33.00 is notably lower than the negotiated rates charged to most major payers, which range from $22 to $36 depending on the specific insurance plan. While the facility's cash price is slightly higher than the state average of $27.00, it remains significantly below the gross chargemaster of $36.00. For patients with high-deductible plans who have not yet met their out-of-pocket limits, paying the cash price directly can sometimes be more cost-effective than relying on insurance, as the insurer's negotiated rate often exceeds the cash amount. It is important to note that while the facility is a Voluntary non-profit Critical Access Hospital, patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill.
When evaluating the cost of this service, it is essential to compare the facility's rates against the federal Medicare benchmark rather than the hospital's inflated list price. The Medicare amount for this procedure is $8.46, which serves as a scientifically validated baseline for the true cost of care, whereas commercial negotiated rates often include significant markups to cover administrative overhead. Although the facility's cash rate is higher than the Medicare amount, it is still substantially lower than the gross charges, indicating a fair pricing structure relative to the national standard. Consumers should avoid accepting summary bills that obscure individual line items and instead request a full itemized audit to ensure no errors or unbundled charges are included in the final invoice.