Blood test, cholesterol (lipid panel)
Facility: Rooks County Health Center
Billing Code: 80061 (CPT)
- CPT Billing Code: 80061
- Insurance Median: $120
- Cash Discount Price: $100
- vs. Medicare Baseline: 8.96x 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 896% of the Medicare baseline (a markup of 796%). 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 |
|---|---|---|
| Veterans Admin - All Plans | $18 | 134% |
| Blue Cross Blue Shield | $43 | 321% |
| Celtic Mcr Adv | $63 | 471% |
| Tricare | $63 | 471% |
| Celtic Comm - All Other Plans | $69 | 515% |
| Preferred Benefits Admin | $120 | 896% |
| Aetna | $120 | 896% |
| UnitedHealthcare | $120 | 896% |
| Preferred Hlthcare - All Other Plans | $127 | 948% |
| Health Partners - All Plans | $127 | 948% |
| Healthy Blue Mcaid - All Plans | $134 | 1001% |
Consumer Guidance & Cost Commentary
For this blood test service at Rooks County Health Center in Plainville, Kansas, the facility's cash price of $100.00 is lower than the state average, offering a potential savings for patients with high-deductible plans who may not qualify for insurance coverage. While the facility's negotiated rate of $120.00 is higher than the cash price, it remains below the gross charge of $134.00, reflecting the typical administrative markup associated with insurance billing. It is important to note that commercial payers in this region have negotiated rates ranging from $18.00 to $134.00, with the lowest negotiated amount of $18.00 being significantly lower than the cash price, which suggests that utilizing an in-network plan could result in a much lower out-of-pocket cost if the patient's deductible has been met.
Patients should be aware that Medicare's benchmark rate for this procedure is $13.39, which serves as a baseline for evaluating the facility's pricing structure. The facility's cash price of $100.00 is approximately 7.5 times the Medicare rate, while the negotiated rate of $120.00 exceeds the Medicare benchmark by roughly 890%. Given that commercial negotiated rates often average between 200% and 300% of Medicare, this specific facility's negotiated rate appears to be on the higher end of the typical range. Consumers are encouraged to request an itemized bill to verify that no unbundled codes or services not rendered are included, and to inquire about prompt-pay discounts, which could further reduce the final amount owed if the bill is settled in full