Blood test, liver function panel
Facility: Wilson Medical Center
Billing Code: 80076 (CPT)
- CPT Billing Code: 80076
- Insurance Median: $32
- Cash Discount Price: $30
- vs. Medicare Baseline: 3.92x 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 392% of the Medicare baseline (a markup of 292%). 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 |
|---|---|---|
| Humana | $5 - $38 | 61% |
| Tricare | $5 - $38 | 61% |
| UnitedHealthcare | $5 - $66 | 61% |
| Aetna | $5 - $71 | 61% |
| Ambetter / Centene | $5 - $71 | 61% |
| Cigna | $8 - $57 | 98% |
| Mulitplan-All Plans | $9 - $65 | 110% |
| Health Partners-All Plans | $9 - $65 | 110% |
| Blue Cross Blue Shield | $10 - $71 | 122% |
Consumer Guidance & Cost Commentary
For the CPT code 80076, representing a blood test for liver function, Wilson Medical Center in Neodesha, KS, lists a gross charge of $41.00. This facility, a Critical Access Hospital owned by the local government, offers a cash median price of $30.00 and a negotiated median of $32.00, which is notably higher than the cash median. When compared to the national benchmark, this service is priced at 3.9 times the Medicare rate of $8.17. While commercial payers like Humana, Tricare, and UnitedHealthcare have negotiated rates ranging from $5 to $71 depending on the specific plan, patients should be aware that cash payments can sometimes be more cost-effective if their insurance negotiated rate exceeds the cash price.
To ensure you are receiving the best possible rate, 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. If you choose to pay out-of-pocket, ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the total cost by offering immediate liquidity incentives. Additionally, since this facility is in-network for major carriers like Aetna and Cigna, verify your specific plan's deductible status before scheduling, as high negotiated rates may still result in significant out-of-pocket costs if your deductible has not been met.