CMS Price Transparency Data

Blood test, cholesterol (lipid panel)

Facility: South Miami Hospital

Billing Code: 80061 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80061
Insurance Median: $41
Cash Discount Price: $101
vs. Medicare Baseline: 3.06x Medicare

The contracted insurance negotiated median rate for a Blood test, cholesterol (lipid panel) at South Miami Hospital is $41. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $101. Compared to the federal Medicare reimbursement reference rate of $13.39, this hospital’s rate is 3.06x the Medicare baseline. Located in 6200 Sw 73Rd St, Miami, FL.

Cash / Self-Pay

$101

Average discount available for prompt cash payment at this facility.

Insurance Median

$41

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: $101 (754%)

Insurance Median: $41 (306%)

Cash: $101 (754% of Medicare)

Ins. Median: $41 (306% 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 306% of the Medicare baseline (a markup of 206%). 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
Aetna	$5 - $202	37%
Amerigroup	$5	37%
Medicaid / KanCare	$5	37%
Sunshine State	$5	37%
UnitedHealthcare	$5 - $252	37%
Vista	$5	37%
Wellcare	$5	37%
Blue Cross Blue Shield	$10 - $163	75%
Medicare (plans)	$13 - $18	97%
Medica Health Plan	$14	105%
Cigna	$15 - $202	112%
Humana	$15	112%
Leon Medical	$15	112%
Avmed	$21 - $125	157%
Non Contracted	$22 - $92	164%
Amerihealth	$27 - $113	202%
International	$38 - $164	284%
Dimension Health Plan	$44 - $227	329%
Affordable	$50 - $214	373%
Phcs	$53 - $227	396%
Quality Health	$53 - $227	396%

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 $101.
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 South Miami 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.