CMS Price Transparency Data

Blood test, liver function panel

Facility: Pinckneyville Community Hospital

Billing Code: 80076 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80076
Insurance Median: $172
Cash Discount Price: $307
vs. Medicare Baseline: 21.05x Medicare

The contracted insurance negotiated median rate for a Blood test, liver function panel at Pinckneyville Community Hospital is $172. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $307. Compared to the federal Medicare reimbursement reference rate of $8.17, this hospital’s rate is 21.05x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$307

Average discount available for prompt cash payment at this facility.

Insurance Median

$172

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$8.17

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $8.17 (100%)

Cash / Self-Pay: $307 (3758%)

Insurance Median: $172 (2105%)

Cash: $307 (3758% of Medicare)

Ins. Median: $172 (2105% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $8.17 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 2105% of the Medicare baseline (a markup of 2005%). 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	$40 - $276	490%
Ambetter / Centene	$40	490%
Blue Cross Blue Shield	$40 - $221	490%
Medicaid / KanCare	$40	490%
Humana	$114	1395%
Umwa Mcr Adv - All Plans	$114	1395%
UnitedHealthcare	$114 - $252	1395%
Wellcare Mcr Adv - All Plans	$114	1395%
Healthlink Hmo	$241	2950%
Phcs - All Other Plans	$252	3084%
Cigna	$253	3097%
Healthlink Ppo - All Other Plans	$253	3097%
Healthlink Work Comp	$253	3097%
Phcs Savility	$261	3195%
Multiplan - All Plans	$276	3378%

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 $307.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 80076.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Pinckneyville Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 80076.
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.