Basic metabolic panel
What goes into a price?
Negotiated prices across insurers
Self pay or cash prices vary by facility when paying out of pocket without insurance benefits. The chart shows you how the lowest and highest amounts facilities charge for this service if you were paying without insurance benefits. If you're uninsured or not submitting a claim to insurance, you also have the right to a Good Faith Estimate under federal law. Contact the provider for a copy of your Good Faith Estimate or to better understand payment options available to you.
Procedures included in this package
This list includes the services and fees bundled into the Basic metabolic panel Standard Service Package (SSP LA004). The final price for the procedure will depend on which services your provider ultimately performs, your insurance plan and your medical benefits.
| Code | Code Type | Description |
|---|---|---|
| Revenue Code 450 | Facility Fee | Emergency Room - General |
| HCPCS 80076 | Optional Fee | Blood Serum Test for Liver Enzyme Activity and Protein Levels |
| Revenue Code 250 | Optional Fee | Pharmacy (Also see 063X, an extension of 250X) - General |
| HCPCS 96374 | Facility Fee | Therapeutic IV Injection of Single Substance/Drug |
| HCPCS 93005 | Optional Fee | Recording 12-lead Electrical Activity of Heart Rhythm |
| Revenue Code 258 | Optional Fee | Pharmacy (Also see 063X, an extension of 250X) - IV solutions |
| HCPCS 81001 | Facility Fee | Automated Urinalysis with Dip Stick/Tablet Reagent and Microscopy |
| HCPCS 80048 | Facility Fee | Basic Metabolic Panel: Calcium, Bicarbonate, Chloride, Creatinine, Glucose, Potassium, Sodium, Bun |
| HCPCS 85025 | Facility Fee | Complete Automated Cbc, Differential Wbc Count |