Blood test, liver function panel
Facility: Nemaha Valley Community Hospital
Billing Code: 80076 (CPT)
- CPT Billing Code: 80076
- Insurance Median: $45
- Cash Discount Price: $77
- vs. Medicare Baseline: 5.51x 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 551% of the Medicare baseline (a markup of 451%). 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 |
|---|---|---|
| Va Ccn - All Plans | $7 | 86% |
| Aetna | $38 - $73 | 465% |
| Humana | $38 | 465% |
| Celtic Comm Exch - All Plans | $42 | 514% |
| Partners Direct Health - All Plans | $45 | 551% |
| Multiplan - All Plans | $77 | 942% |
| Midlands Choice - All Plans | $82 | 1004% |
| Health Partners - All Plans | $82 | 1004% |
Consumer Guidance & Cost Commentary
For the liver function panel procedure (CPT 80076) at Nemaha Valley Community Hospital in Seneca, KS, the cash median price is $77.00, which is lower than the facility's negotiated rates of $45.00 to $82.00 across eight payers. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should note that cash payments may offer savings compared to insurance negotiated rates, particularly if your plan has a high deductible. The Medicare benchmark for this service is $8.17, providing a clear baseline to evaluate the facility's pricing; the cash rate represents a significant markup over this federal standard, whereas the negotiated rates range from approximately 450% to 1000% of the Medicare amount.
To ensure you receive the most accurate pricing, it is essential to request an itemized billing audit before finalizing payment, as summary bills often obscure individual code costs and potential errors. Additionally, ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if settled upfront, bypassing the administrative costs associated with insurance claims. Since the facility is located in Seneca (ZIP 66538), verify whether these rates align with local county or state averages for similar Critical Access Hospitals, and remember that the No Surprises Act protects you from balance billing for out-of-network services at in-network facilities.