Blood test, cholesterol (lipid panel)
Facility: Mercy Hospital Columbus
Billing Code: 80061 (CPT)
- CPT Billing Code: 80061
- Insurance Median: $85
- Cash Discount Price: $76
- vs. Medicare Baseline: 6.35x 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 635% of the Medicare baseline (a markup of 535%). 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 |
|---|---|---|
| Humana | $12 - $111 | 90% |
| Blue Cross Blue Shield | $12 - $85 | 90% |
| UnitedHealthcare | $12 - $97 | 90% |
| Medicaid / KanCare | $12 - $85 | 90% |
| Medicare (plans) | $13 - $88 | 97% |
| Health Systems Inc Contracted [320174] | $50 | 373% |
| Insurance System Inc Contracted [320465] | $50 | 373% |
| Administrative Payor Contracted [320005] | $53 | 396% |
| Elara Caring Aspire Hospice [20433] | $85 | 635% |
| Aetna | $85 - $105 | 635% |
| Home State Health Plan Contracted [320187] | $85 | 635% |
| Mercy Hospice Okc [20252] | $85 | 635% |
| Cigna | $85 | 635% |
| Indian Health Service Contracted [320198] | $85 | 635% |
| Centurion Of Missouri [20459] | $85 | 635% |
| Tricare | $85 | 635% |
| Halo Hcr Inc Hospice [20432] | $85 | 635% |
| Provider Partners Health Plans Contracted [320450] | $85 | 635% |
| Qual Choice Contracted [320325] | $85 | 635% |
| Halo Hcr Inc Hospice Contracted [320432] | $85 | 635% |
| Cross Timbers Hospice [20098] | $85 | 635% |
| Globalhealth Contracted [320145] | $85 | 635% |
| Medical Associates Health Contracted [320444] | $85 | 635% |
| Pace Of The Ozarks Contracted [320518] | $85 | 635% |
| Dept Of Veteran Affairs Contracted [320106] | $85 | 635% |
| Cherokee Nation Health Serv Contracted [320066] | $85 | 635% |
| Novasys Contracted [320285] | $85 | 635% |
| Mercy Mgd Behavioral Health Contracted [320259] | $85 | 635% |
| Ambetter / Centene | $85 | 635% |
| Kindful Hospice Contracted [320434] | $85 | 635% |
| Kindful Hospice [20434] | $85 | 635% |
| Healthscope Contracted [320182] | $90 | 672% |
| Workers Comp [20426] | $94 - $99 | 702% |
| United Medical Resources Contracted [320454] | $97 - $111 | 724% |
| Healthlink Contracted [320179] | $105 - $111 | 784% |
| First Health Contracted [320128] | $105 | 784% |
| Medica Contracted [320239] | $105 | 784% |
| Mercy Benefit Admin Contracted [320251] | $105 - $111 | 784% |
| Usa Managed Care Org Contracted [320429] | $105 | 784% |
| American Healthcare Alliance Contracted [320020] | $105 | 784% |
| Federal Medical Center Contracted [320127] | $105 | 784% |
| Preferred Health Plan Contracted [320522] | $105 | 784% |
| Point C Contracted [320238] | $111 | 829% |
| Auxiant Contracted [320462] | $111 | 829% |
| 90 Degree Benefits Contracted [320436] | $111 | 829% |
| Ebms Contracted [320493] | $111 | 829% |
| Show-Me Health Administrators Contracted [320483] | $111 | 829% |
| Aither Health Contracted [320449] | $111 | 829% |
| Edison Health Solutions Contracted [320502] | $111 | 829% |
| Reflect Health Contracted [320492] | $111 | 829% |
| Private Health Care Systems Contracted [320320] | $111 | 829% |
| Yuzu Health Contracted [320521] | $111 | 829% |
| Ppo Plus Contracted [320310] | $111 | 829% |
| Benefit Management Contracted [320052] | $111 | 829% |
| Imagine 360 Contracted [320494] | $111 | 829% |
Consumer Guidance & Cost Commentary
For the blood test, cholesterol (lipid panel) service at Mercy Hospital Columbus, the facility's cash price is $76.00, which is lower than the state average of $85.00. While many commercial payers negotiate rates ranging from $12 to $111, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to note that commercial negotiated rates frequently include administrative overhead and do not represent the true cost of care; comparing these rates to the Medicare benchmark of $13.39 reveals significant markups. Additionally, the facility's gross charge of $117.00 serves as a high reference point, but patients should focus on the cash or negotiated rates rather than the list price when evaluating affordability.
Patients should be aware that insurance claims can sometimes trigger balance billing if services are rendered by out-of-network providers, even at an in-network hospital, though the No Surprises Act protects against surprise bills for emergency care and non-emergency services at in-network facilities. To avoid unexpected costs, consumers should request an itemized billing audit to verify that all charges correspond to services actually rendered and that no unbundled codes or errors exist, as over 80% of hospital bills contain mistakes. Furthermore, before scheduling, patients should explicitly ask for self-pay or prompt-pay discounts, which can reduce the bill by 20% to 50% if paid in full upfront, effectively bypassing the administrative costs associated with insurance claims processing.