Blood test, cholesterol (lipid panel)
Facility: Graham County Hospital
Billing Code: 80061 (CPT)
- CPT Billing Code: 80061
- Insurance Median: $48
- Cash Discount Price: $70
- vs. Medicare Baseline: 3.58x 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 358% of the Medicare baseline (a markup of 258%). 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 | $9 - $66 | 67% |
| Medicaid / KanCare | $21 | 157% |
| Blue Cross Blue Shield | $43 | 321% |
| Medicare (plans) | $52 | 388% |
| Celtic Commercial-All Other Plans | $58 | 433% |
| Wppa (Providers Care)-All Plans | $66 | 493% |
Consumer Guidance & Cost Commentary
For the blood test, cholesterol (lipid panel) procedure at Graham County Hospital in Hill City, KS, the cash price is $70.00, which matches the facility's median negotiated rate. This cash price is significantly higher than the Medicare benchmark of $13.39, reflecting a markup of 3.6 times the federal baseline. While commercial payers negotiate rates ranging from $9 to $66 depending on the plan, patients with high-deductible plans may find paying the full cash price of $70.00 more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. It is important to verify your specific plan's deductible status before scheduling, as paying out-of-pocket can sometimes result in lower total costs if the insurance allowed amount is higher than the cash price.
Patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before check-in, as these upfront payment incentives can reduce the final bill by 20% to 50%. Although the facility is a Critical Access Hospital owned by the local government, the absence of a listed facility rating suggests further review of their pricing structure may be beneficial. To ensure you are not overcharged, request a detailed, itemized bill that breaks down every CPT code and unit cost, as summary bills often hide errors or unbundled charges. Given that over 80% of hospital bills contain mistakes, reviewing the line-by-line statement is the most effective way to identify and dispute any inaccuracies before payment is made.