Blood test, cholesterol (lipid panel)
Facility: Stormont Vail Hospital
Billing Code: 80061 (CPT)
- CPT Billing Code: 80061
- Insurance Median: $35
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.61x 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 $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 261% of the Medicare baseline (a markup of 161%). 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 | $14 | 105% |
| Blue Cross Blue Shield | $14 - $43 | 105% |
| Ambetter / Centene | $14 | 105% |
Consumer Guidance & Cost Commentary
For this blood test procedure at Stormont Vail Hospital in Topeka, KS, the facility's negotiated rates are significantly higher than the state average. While the median amount paid by insurance is $13,130.00, the facility's negotiated rate is only $35.00, which is lower than the state average of $35.00. This suggests that while the hospital charges a premium for in-network coverage, the specific contract terms for this service may align with or slightly undercut regional pricing norms. However, patients should be aware that cash-pay options are not listed for this code, meaning the negotiated rate serves as the primary benchmark for insured patients rather than a discount compared to a cash price.
It is important to understand that commercial insurance rates often include administrative overheads that can inflate the final cost compared to direct payment. Although this specific service does not have a listed cash median, patients with high-deductible plans should always inquire about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fees can sometimes be lower than the insurance negotiated rate if the patient's plan has not yet met its deductible. Furthermore, if any unexpected charges arise from out-of-network ancillary services, the No Surprises Act provides federal protections against balance billing for emergency and non-emergency care at in-network facilities. Consumers are encouraged to request a full itemized bill to verify that all charges are accurate and to dispute any errors formally in writing if needed.