CMS Price Transparency Data

Blood test, basic metabolic panel

Facility: UPMC Somerset

Billing Code: 80048 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80048
Insurance Median: $30
Cash Discount Price: $51
vs. Medicare Baseline: 3.55x Medicare

The contracted insurance negotiated median rate for a Blood test, basic metabolic panel at UPMC Somerset is $30. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $51. Compared to the federal Medicare reimbursement reference rate of $8.46, this hospital’s rate is 3.55x the Medicare baseline. Located in 225 South Center Avenue, Somerset, PA.

Cash / Self-Pay

$51

Average discount available for prompt cash payment at this facility.

Insurance Median

$30

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%)

Cash / Self-Pay: $51 (603%)

Insurance Median: $30 (355%)

Cash: $51 (603% of Medicare)

Ins. Median: $30 (355% 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 355% of the Medicare baseline (a markup of 255%). 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
Amerihealth Caritas	$8 - $11	95%
Blue Cross Blue Shield	$8 - $22	95%
UnitedHealthcare	$8 - $32	95%
Upmc Health Plan	$8 - $55	95%
Upmc Work Partners	$8	95%
Cbhnp	$9	106%
Highmark Wholecare (Prev Gateway)	$9 - $12	106%
Ccbhn	$12	142%
Geisinger	$13 - $36	154%
Aetna	$31 - $37	366%
Multiplan	$38 - $60	449%
Galaxy Health Plan	$50 - $60	591%
Humana	$58 - $69	686%

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 $51.
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 UPMC Somerset 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.