CMS Price Transparency Data

Blood test, cholesterol (lipid panel)

Facility: St Francis Hospital

Billing Code: 80061 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80061
Insurance Median: $90
Cash Discount Price: $254
vs. Medicare Baseline: 6.72x Medicare

The contracted insurance negotiated median rate for a Blood test, cholesterol (lipid panel) at St Francis Hospital is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $254. Compared to the federal Medicare reimbursement reference rate of $13.39, this hospital’s rate is 6.72x the Medicare baseline. Located in 7Th and Clayton Sts, Wilmington, DE.

Cash / Self-Pay

$254

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$13.39

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $13.39 (100%)

Cash / Self-Pay: $254 (1897%)

Insurance Median: $90 (672%)

Cash: $254 (1897% of Medicare)

Ins. Median: $90 (672% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $13.39 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 672% of the Medicare baseline (a markup of 572%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$13 - $204	97%
Blue Shield - De (Highmark) Medciare Advantage	$13	97%
Highmark Health Options Dual Plan	$13	97%
Pace-Trinity Health	$13	97%
Saint Francis Life	$13	97%
Aetna	$14 - $254	105%
Cigna	$14 - $242	105%
Medicare (plans)	$14	105%
Coventry	$16	119%
Delaware First Health	$28	209%
Blue Benefit Administrators Of Massachusetts	$90	672%
Blue Care Network	$90	672%
Blue Distinction Transplant	$90	672%
Blue Shield - Ca	$90	672%
Blue Shield - Id (Regence)	$90	672%
Blue Shield - Ny Highmark Northeastern	$90	672%
Blue Shield - Ny Highmark Western	$90	672%
Blue Shield - Pa (Highmark)	$90	672%
Blue Shield - Wa (Regence)	$90	672%
Medicaid / KanCare	$137	1023%
Amerihealth	$204	1524%
Meritain	$254	1897%
Trustmark Small Business Benefits	$254	1897%
Devon Health Services	$371	2771%
Galaxy Health Network	$371	2771%
Multiplan	$371	2771%
Prime Health Services	$371	2771%
Three Rivers Provider Network	$371	2771%
Wc Corvel	$371	2771%
Geha	$375	2801%
UnitedHealthcare	$375	2801%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $254.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 80061.

Insurance In-Network Protection Plan

Contact your insurance company to confirm St Francis Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 80061.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.