Blood test, liver function panel
Facility: Ashland Health Center
Billing Code: 80076 (CPT)
- CPT Billing Code: 80076
- Insurance Median: $46
- Cash Discount Price: $37
- vs. Medicare Baseline: 5.63x 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 563% of the Medicare baseline (a markup of 463%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $15 | 184% |
| Compalliance-All Plans | $37 | 453% |
| Health Partners Of Kansas-All Plans | $39 | 477% |
| Multiplan-All Plans | $45 | 551% |
| Medicare (plans) | $46 | 563% |
| Medicaid / KanCare | $46 | 563% |
| Aetna | $46 | 563% |
| UnitedHealthcare | $46 | 563% |
| Medica Mcare - All Plans | $46 | 563% |
| Health Choice-All Plans | $46 | 563% |
| Healthy Blue Mcr Adv - All Other Plans | $46 | 563% |
| Providers Care (Wppa)-All Plans | $69 | 845% |
Consumer Guidance & Cost Commentary
For the CPT code 80076, representing a liver function panel at Ashland Health Center in Ashland, KS, the facility's negotiated rates across 12 payers average $46.00, which matches the median paid amount. This negotiated rate is notably higher than the cash median of $37.00, illustrating a common scenario where paying out-of-pocket can be more cost-effective for patients with high-deductible plans or those without insurance. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should verify their specific plan's allowed amount before scheduling, as some in-network contracts may result in higher out-of-pocket costs than the cash price. Additionally, patients should inquire about "self-pay" or "prompt-pay" discounts prior to check-in, as these upfront fee reductions can further lower the final bill by bypassing administrative claim processing costs.
It is important to distinguish between the facility's gross charge of $46.00 and the actual amounts paid by insurers, as the latter reflects the contractual ceiling rather than the full list price. Although the data does not provide specific county or state average comparisons for this exact procedure, the facility's rates are benchmarked against Medicare, which sets a fixed reimbursement rate of $8.17 for this service. Commercial negotiated rates often exceed Medicare benchmarks due to administrative overhead and contract dynamics, but they serve as a protective ceiling for in-network members. If a patient receives a bill exceeding the negotiated rate, they may be subject to balance billing if the provider is out-of-network, though the No Surprises Act generally protects patients from such surprise charges for emergency care and non-emergency services at in-network facilities.