Blood test, liver function panel
Facility: Graham County Hospital
Billing Code: 80076 (CPT)
- CPT Billing Code: 80076
- Insurance Median: $34
- Cash Discount Price: $49
- vs. Medicare Baseline: 4.16x 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 416% of the Medicare baseline (a markup of 316%). 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 | $4 - $47 | 49% |
| Medicaid / KanCare | $13 | 159% |
| Blue Cross Blue Shield | $32 | 392% |
| Medicare (plans) | $37 | 453% |
| Celtic Commercial-All Other Plans | $40 | 490% |
| Wppa (Providers Care)-All Plans | $47 | 575% |
Consumer Guidance & Cost Commentary
For the CPT code 80076, representing a liver function panel at Graham County Hospital in Hill City, Kansas, the cash price is $49.00. This cash rate is identical to the facility's median negotiated rate of $43.00 and the state average of $49.00, indicating that paying out-of-pocket here is competitive with the broader market. While the hospital is a Critical Access Hospital owned by the local government, patients should be aware that commercial payers like UnitedHealthcare and Blue Cross Blue Shield have negotiated rates ranging from $13.00 to $47.00 across their plans. In this specific case, the cash price matches the gross charge, meaning there is no significant discount available for self-pay compared to the list price, though patients should still inquire about prompt-pay discounts before scheduling to ensure they are not being billed the full amount upfront.
The Medicare allowed amount for this service is $8.17, which serves as a key benchmark for evaluating the facility's pricing structure. The facility's cash rate of $49.00 is approximately 6 times higher than the Medicare benchmark, reflecting the typical markup found in commercial billing where administrative costs and network negotiations drive prices well above the federal baseline. For patients with high-deductible plans, it is important to note that while insurance negotiated rates can sometimes exceed cash prices, the data here shows the cash rate is already at the median for the state. To avoid unexpected costs, patients should request an itemized bill to verify that no unbundled charges or services not rendered are included, and they should confirm with the billing department whether any prompt-pay discounts apply to the final invoice before payment