CMS Price Transparency Data

Blood test, basic metabolic panel

Facility: St Nicholas Hospital

Billing Code: 80048 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 80048
  • Insurance Median: $11
  • Cash Discount Price: $47
  • vs. Medicare Baseline: 1.30x Medicare
The contracted insurance negotiated median rate for a Blood test, basic metabolic panel at St Nicholas Hospital is $11. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $47. Compared to the federal Medicare reimbursement reference rate of $8.46, this hospital’s rate is 1.30x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$47

Average discount available for prompt cash payment at this facility.

Insurance Median
$11

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: $47 (556%)
Insurance Median: $11 (130%)
Cash: $47 (556% of Medicare)
Ins. Median: $11 (130% 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Hshs Employees $6 - $70 71%
Molina Healthcare Of Wi $6 - $65 71%
Arise Health Plan $7 - $78 83%
Wea Provider Network $7 - $94 83%
Aetna $8 - $130 95%
Blue Cross Blue Shield $8 - $30 95%
Cigna $8 - $91 95%
Humana $8 - $110 95%
Interplan $8 - $91 95%
Medica $8 95%
Medicare (plans) $8 95%
Molina Healthcare $8 - $9 95%
Network Health Plan $8 - $91 95%
Security Health Plan $8 - $83 95%
UnitedHealthcare $8 - $10 95%
Community Care Family Care $9 106%
Health Care Alliance $9 - $95 106%
Health Eos $9 - $98 106%
Healthsmart $9 - $98 106%
Managed Health Services $9 106%
Medicaid / KanCare $9 106%
Meridian Health Plan $9 106%
Triology $9 - $103 106%
Choicecare $10 - $110 118%
Multiplan/Phcs $10 - $109 118%
P360 Small Group $10 118%
Prevea Health Network $10 118%
Wisconsin Physician Service $10 - $104 118%
First Health $11 - $124 130%
North Central Healthcare Alliance $11 - $120 130%
Caterpillar, Inc. $12 - $130 142%
Cofinity $12 - $130 142%
Live360 $12 - $130 142%
Naphcare $19 225%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3100 Superior Ave, Sheboygan, WI 53081
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals