CMS Price Transparency Data

Blood test, basic metabolic panel

Facility: Harlem Hospital Center

Billing Code: 80048 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80048
Insurance Median: $65
Cash Discount Price: Unavailable
vs. Medicare Baseline: 7.68x Medicare

The contracted insurance negotiated median rate for a Blood test, basic metabolic panel at Harlem Hospital Center is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $8.46, this hospital’s rate is 7.68x the Medicare baseline. Located in 506 Lenox Avenue, New York, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$65

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$8.46

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $8.46 (100%)

Insurance Median: $65 (768%)

Ins. Median: $65 (768% of 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.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$5 - $19	59%
Healthfirst	$5 - $147	59%
Elderplan	$8	95%
Fidelis	$8 - $147	95%
Magnacare	$10	118%
Oxford	$12	142%
United	$12 - $82	142%
Centerlight	$13	154%
Oscar	$13	154%
Wellcare	$16	189%
Carelon	$17 - $65	201%
Emblem	$19 - $88	225%
Cigna	$21	248%
Multiplan	$21	248%
Local 1199	$23	272%
Villagecare Max	$23	272%
Vnsny	$23 - $67	272%
Blue Cross Blue Shield	$28 - $147	331%
Metroplus	$62 - $147	733%
Amidacare	$65	768%
Senior Whole Health	$65	768%
United Behavioral Health	$65 - $72	768%
Affinity	$67 - $147	792%
Carelon (Amida Care)	$67	792%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $X.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 80048.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Harlem Hospital Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 80048.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.