Blood test, liver function panel
Facility: Fredonia Regional Hospital
Billing Code: 80076 (CPT)
- CPT Billing Code: 80076
- Insurance Median: $61
- Cash Discount Price: $68
- vs. Medicare Baseline: 7.47x 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 747% of the Medicare baseline (a markup of 647%). 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 | $6 - $61 | 73% |
| Blue Cross Blue Shield | $32 - $33 | 392% |
| Aetna | $34 - $61 | 416% |
| Veterans Programs - All Plans | $34 | 416% |
| Reserve National-All Plans | $61 | 747% |
| Meritain-All Plans | $61 | 747% |
| Cigna | $61 | 747% |
Consumer Guidance & Cost Commentary
For the CPT code 80076, representing a blood test for liver function, the cash price at Fredonia Regional Hospital in Kansas is $68.00. This cash rate is identical to the facility's median negotiated rate of $61.00 and the median paid amount of $42.00, which are significantly lower than the gross charge of $68.00. While the facility is a Critical Access Hospital owned by the local government, patients should note that cash payments can sometimes be more cost-effective than using insurance if the patient's deductible has not yet been met, as the negotiated rates paid by insurers may exceed the cash price. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available before scheduling the test.
When comparing pricing to federal benchmarks, the Medicare amount for this service is $8.17, which serves as a baseline for evaluating the facility's markup. The cash price of $68.00 represents a substantial increase over the Medicare rate, illustrating the difference between government-set reimbursement and commercial pricing. Although the data does not provide specific state or county average figures for comparison, the facility's location in Fredonia, KS (zip 66736) is relevant for understanding local cost structures. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it is essential to verify network status and request an itemized bill to ensure no unexpected charges occur.