CMS Price Transparency Data

Blood test, basic metabolic panel

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 80048 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80048
Insurance Median: $420
Cash Discount Price: $536
vs. Medicare Baseline: 49.65x Medicare

The contracted insurance negotiated median rate for a Blood test, basic metabolic panel at UPMC Children's Hospital of Pittsburgh is $420. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $536. Compared to the federal Medicare reimbursement reference rate of $8.46, this hospital’s rate is 49.65x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$536

Average discount available for prompt cash payment at this facility.

Insurance Median

$420

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: $536 (6336%)

Insurance Median: $420 (4965%)

Cash: $536 (6336% of Medicare)

Ins. Median: $420 (4965% 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 4965% of the Medicare baseline (a markup of 4865%). 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	$8 - $492	95%
Health Plan Of Upper Ohio Valley	$8 - $581	95%
Amerihealth Caritas	$9 - $35	106%
Blue Cross Blue Shield	$9 - $96	106%
Cigna	$9 - $492	106%
Upmc Health Plan	$22 - $68	260%
Health Partners Plans (Jefferson Health Plan)	$36	426%
UnitedHealthcare	$37 - $420	437%
Geisinger	$38 - $402	449%
Highmark Wholecare (Prev Gateway)	$38	449%
Pa Health & Wellness	$38	449%
Intergroup	$581 - $760	6868%
Coventry/First Health	$715	8452%
Saudi Armed Forces	$715	8452%
Health Payors Organization	$760	8983%
Multiplan	$760	8983%
National Provider Network	$805	9515%
Private Health Care Systems	$805	9515%

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 $536.
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 Children's Hospital of Pittsburgh 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.