Blood test, cholesterol (lipid panel)
Facility: Mcpherson Hospital
Billing Code: 80061 (CPT)
- CPT Billing Code: 80061
- Insurance Median: $71
- Cash Discount Price: $62
- vs. Medicare Baseline: 5.30x 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 530% of the Medicare baseline (a markup of 430%). 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 |
|---|---|---|
| Tricare | $12 | 90% |
| Humana | $13 | 97% |
| Va Ccn - All Plans | $13 | 97% |
| Blue Cross Blue Shield | $13 | 97% |
| UnitedHealthcare | $13 - $208 | 97% |
| Healthy Blue Mcr Adv | $13 | 97% |
| Wellcare Mcr Adv - All Plans | $13 | 97% |
| Ambetter / Centene | $15 | 112% |
| Wppa - All Plans | $50 - $146 | 373% |
| Medical Associates - All Plans | $53 - $156 | 396% |
| Central Plains - All Plans | $53 - $156 | 396% |
| Christian Health Aid - All Plans | $57 - $166 | 426% |
| Aetna | $59 - $208 | 441% |
| Multiplan - All Plans | $64 - $187 | 478% |
| First Health - All Plans | $67 - $198 | 500% |
| Cigna | $67 - $198 | 500% |
| Health Partners - All Plans | $67 - $198 | 500% |
| Medicaid / KanCare | $71 - $208 | 530% |
| Health Blue Mcaid - All Other Plans | $72 - $212 | 538% |
Consumer Guidance & Cost Commentary
For the blood test, cholesterol (lipid panel) service at McPherson Hospital, the cash median price is $62.00, which is lower than the facility's negotiated median paid rate of $67.00. This suggests that patients with high-deductible plans might save money by paying cash upfront, as the insurance negotiated rates for this procedure can sometimes exceed the cash price. While the facility offers a cash median of $62.00, it is important to note that this amount is significantly higher than the Medicare benchmark of $13.39, indicating a substantial markup relative to the federal government's fixed reimbursement rate. To maximize savings, patients should inquire about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%.
The facility's pricing structure varies considerably across different payers, with negotiated rates ranging from $12 for Tricare up to $212 for Health Blue Medicaid. For instance, UnitedHealthcare, which covers 7 plans, has a wide range of negotiated rates from $13 to $208, while Medicaid/KanCare plans show a range from $71 to $208. These commercial rates are notably higher than the Medicare amount of $13.39, reflecting the administrative costs and contract dynamics inherent in insurance billing. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but they should still request an itemized bill to verify that all charges are accurate and that no services were rendered but billed. Always confirm your deductible status before proceeding