Blood test, liver function panel
Facility: Stormont Vail Hospital
Billing Code: 80076 (CPT)
- CPT Billing Code: 80076
- Insurance Median: $26
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.18x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 318% of the Medicare baseline (a markup of 218%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| UnitedHealthcare | $8 | 98% |
| Ambetter / Centene | $8 | 98% |
| Blue Cross Blue Shield | $8 - $32 | 98% |
Consumer Guidance & Cost Commentary
For the CPT code 80076, representing a blood test for liver function, the negotiated payment amount at Stormont Vail Hospital in Topeka, KS, is $17,761. This figure is significantly higher than the Medicare benchmark of $8.17, reflecting the standard administrative markup associated with commercial insurance contracts. While the facility offers a negotiated rate of $26.00, this amount remains substantially above the cash median, which is not available for this service. Patients with high-deductible plans should be aware that paying cash upfront might result in lower out-of-pocket costs if the insurance negotiated rate exceeds the cash price, though the data indicates the cash option is currently unavailable for this specific procedure.
It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, unexpected charges can still occur if ancillary services like specific lab components are billed separately. To avoid potential errors or overcharges, patients should request a full itemized bill before paying, as summary invoices often obscure individual line items. Additionally, since the facility is a voluntary non-profit acute care hospital, patients should proactively inquire about "self-pay" or "prompt-pay" discounts, which can reduce the total cost if settled within a short window, bypassing the administrative overhead of the insurance claims process.