Blood test, cholesterol (lipid panel)
Facility: Hamilton County Hospital
Billing Code: 80061 (CPT)
- CPT Billing Code: 80061
- Insurance Median: $39
- Cash Discount Price: $40
- vs. Medicare Baseline: 2.91x 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 291% of the Medicare baseline (a markup of 191%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $20 - $43 | 149% |
| First Health Coventry - All Plans | $34 | 254% |
| Cigna | $38 | 284% |
| UnitedHealthcare | $38 | 284% |
| Va Ccn - All Plans | $40 | 299% |
| Aetna | $68 | 508% |
Consumer Guidance & Cost Commentary
For the blood test, cholesterol (lipid panel) service at Hamilton County Hospital in Syracuse, KS, the cash price is $40.00, which matches the facility's gross charge. This cash rate is significantly lower than the negotiated rates paid by most major insurers, with Blue Cross Blue Shield paying up to $43.00 and Aetna paying the full $68.00. Because commercial insurance contracts often include administrative overhead and risk premiums, the cash price can be a more cost-effective option for patients with high-deductible plans or those who have already met their out-of-pocket limits. To maximize savings, patients should explicitly ask the registration desk about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the higher insurance negotiated rates.
While the facility is a Critical Access Hospital owned by the local government, the data does not provide a specific comparison to Kansas or Hamilton County average rates for this procedure. However, the Medicare benchmark of $13.39 serves as a clear baseline, indicating that the cash price of $40.00 represents a markup of approximately 298% over the federal government's calculated cost. This highlights the importance of understanding that commercial rates are not always reflective of the true cost of care. If a patient receives this service out-of-network or encounters unexpected charges, they may be subject to balance billing for the difference between the allowed amount and the full charge, though federal protections like the No Surprises Act may apply to emergency or non-emergency services at in-network facilities. Consumers are advised to request a detailed, itemized bill to verify all charges and dispute any unbundled codes or services not rendered.