Blood test, cholesterol (lipid panel)
Facility: Holton Community Hospital
Billing Code: 80061 (CPT)
- CPT Billing Code: 80061
- Insurance Median: $58
- Cash Discount Price: $63
- vs. Medicare Baseline: 4.33x 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 433% of the Medicare baseline (a markup of 333%). 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 |
|---|---|---|
| Aetna | $34 - $105 | 254% |
| UnitedHealthcare | $34 - $105 | 254% |
| Humana | $34 - $56 | 254% |
| Kansas Superior Select - All Plans | $35 - $57 | 261% |
| Blue Cross Blue Shield | $43 | 321% |
| Preferred Health Freedom | $53 - $87 | 396% |
| Preferred Health Fn Select - All Other Plans | $53 - $87 | 396% |
| Preferred Health Professionals | $53 - $87 | 396% |
| Wppa Providers - All Plans | $61 - $100 | 456% |
| Medicaid / KanCare | $64 - $105 | 478% |
Consumer Guidance & Cost Commentary
For the blood test, cholesterol (lipid panel) service at Holton Community Hospital in Holton, KS, the facility's cash price of $63.00 is notably lower than the average commercial negotiated rates paid by insurance carriers, which range from $34 to $105 depending on the plan. While the hospital is a Critical Access Hospital with a voluntary non-profit status, patients should be aware that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures; therefore, paying out-of-pocket can sometimes result in significant savings compared to using insurance, particularly for those with high-deductible plans. The facility's cash rate also sits below the state average for this procedure, offering a competitive baseline for self-pay patients who have not yet met their deductible or wish to avoid the multi-layered billing cycle associated with commercial insurance.
The Medicare benchmark for this service is $13.39, which serves as a critical reference point for evaluating the facility's pricing markup. Although the hospital's cash rate of $63.00 is higher than the Medicare amount, it remains substantially lower than the gross chargemaster price of $85.00 and the median negotiated rate of $58.00 reported for this code. Patients are encouraged to verify their specific plan's allowed amount before scheduling, as some in-network contracts may result in higher out-of-pocket costs than the cash price. Additionally, individuals should proactively inquire about "self-pay" or "prompt-pay" discounts at the time of registration, as these upfront payment incentives can further reduce the final bill by bypassing standard claims processing fees and administrative costs.