CMS Price Transparency Data

Blood test, basic metabolic panel

Facility: UPMC Northwest

Billing Code: 80048 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80048
Insurance Median: $57
Cash Discount Price: $85
vs. Medicare Baseline: 6.74x Medicare

The contracted insurance negotiated median rate for a Blood test, basic metabolic panel at UPMC Northwest is $57. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $85. Compared to the federal Medicare reimbursement reference rate of $8.46, this hospital’s rate is 6.74x the Medicare baseline. Located in 100 Fairfield Drive, Seneca, PA.

Cash / Self-Pay

$85

Average discount available for prompt cash payment at this facility.

Insurance Median

$57

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: $85 (1005%)

Insurance Median: $57 (674%)

Cash: $85 (1005% of Medicare)

Ins. Median: $57 (674% 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 674% of the Medicare baseline (a markup of 574%). 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
Blue Cross Blue Shield	$8 - $72	95%
Geisinger	$8	95%
Upmc Health Plan	$8 - $15	95%
Upmc Work Partners	$8	95%
Aetna	$9 - $92	106%
Amerihealth Caritas	$9 - $15	106%
Highmark Wholecare (Prev Gateway)	$9 - $14	106%
Pa Health & Wellness	$9 - $16	106%
UnitedHealthcare	$9 - $11	106%
Cigna	$56 - $92	662%
Intergroup	$92 - $3,704	1087%
Coventry/First Health	$99	1170%
Health Coalition Partners	$102	1206%
Private Health Care Systems	$113	1336%
Humana	$120	1418%

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 $85.
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 Northwest 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.