Blood test, cholesterol (lipid panel)
Facility: Kansas City Orthopaedic Institute
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 | $13 | 97% |
| Cigna | $13 | 97% |
| Aetna | $13 | 97% |
| Blue Cross Blue Shield | $35 | 261% |
Consumer Guidance & Cost Commentary
For the blood test, cholesterol (lipid panel) procedure at Kansas City Orthopaedic Institute in Leawood, KS, the facility's negotiated rate is $35.00, which is significantly higher than the state average of $13.39. While commercial payers like UnitedHealthcare, Cigna, and Aetna also pay $13.00 per plan, Blue Cross Blue Shield pays $35.00 across five plans. Because this negotiated rate exceeds the state average, patients with high-deductible plans might find it beneficial to pay cash directly, as the cash price could be lower than the insurance allowed amount. However, since cash and negotiated rates are currently null in the data, patients should verify current self-pay or prompt-pay discounts with the hospital before scheduling to ensure they are not overpaying.
It is important to understand that commercial negotiated rates often include administrative overhead, which can inflate the baseline price by 20% to 40% compared to the true cost of care. The facility's rate of $35.00 is 2.6 times the Medicare benchmark of $13.39, indicating a markup that exceeds the typical fair pricing range of 120% to 150% of Medicare. If you receive a bill for this service, you should request an itemized billing audit to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain mistakes. Additionally, if you are out-of-network, the No Surprises Act may protect you from balance billing for emergency care or non-emergency services at in-network facilities, so you should dispute any unexpected charges immediately