Blood test, liver function panel
Facility: Hiawatha Community Hospital
Billing Code: 80076 (CPT)
- CPT Billing Code: 80076
- Insurance Median: $64
- Cash Discount Price: $82
- vs. Medicare Baseline: 7.83x 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 783% of the Medicare baseline (a markup of 683%). 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 | $30 - $32 | 367% |
| Aetna | $30 - $66 | 367% |
| UnitedHealthcare | $30 - $70 | 367% |
| Humana | $31 | 379% |
| Ambetter / Centene | $36 | 441% |
| Oscar - All Plans | $62 | 759% |
| Centrus Health Direct - All Plans | $62 | 759% |
| Preferred Hlth - All Plans | $74 | 906% |
| Cigna | $78 | 955% |
| Wppa Providrs Care - All Plans | $78 | 955% |
| Midlands Choice - All Plans | $80 | 979% |
| Multiplan - All Plans | $80 | 979% |
| Healthy Blue Mcaid - All Plans | $82 | 1004% |
Consumer Guidance & Cost Commentary
For the CPT code 80076, representing a blood test and liver function panel, Hiawatha Community Hospital in Hiawatha, KS, lists a cash median price of $82.00. This cash rate is identical to the facility's gross charge and the Medicare amount of $8.17 multiplied by a standard factor, though the specific comparison metric provided indicates a 7.8% variance relative to Medicare. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. For instance, the median negotiated rate across payers is $64.00, which is lower than the cash price, but individual payer contracts vary significantly, ranging from $30 to $82 depending on the insurer. Patients with high-deductible plans may find paying the $82.00 cash price directly more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if their deductible has not been met or if the insurer's allowed amount is high.
To ensure you are not overcharged, it is crucial to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. While the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still verify that all ancillary services, such as specific lab components, are properly classified. Additionally, because hospitals often offer prompt-pay discounts of 20% to 50% for upfront payment, you should explicitly ask the billing department about self-pay or