Blood test, cholesterol (lipid panel)
Facility: Ellsworth County Medical Center
Billing Code: 80061 (CPT)
- CPT Billing Code: 80061
- Insurance Median: $48
- Cash Discount Price: $54
- 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 |
|---|---|---|
| Triwest -All Plans | $25 | 187% |
| Healthy Blue Mcr Adv | $25 | 187% |
| Humana | $25 - $51 | 187% |
| Va Ccn-All Plans | $25 | 187% |
| UnitedHealthcare | $35 - $54 | 261% |
| Blue Cross Blue Shield | $41 - $43 | 306% |
| Aetna | $48 | 358% |
| First Health - All Plans | $48 | 358% |
| Cigna | $51 | 381% |
| Healthy Blue Mcaid- All Other Plans | $54 | 403% |
| Medicaid / KanCare | $54 | 403% |
| Coventry Mcaid-All Plans | $54 | 403% |
| Providers Care-Wppa-All Plans | $80 | 597% |
Consumer Guidance & Cost Commentary
For the blood test, cholesterol (lipid panel) procedure at Ellsworth County Medical Center in Ellsworth, KS, the cash median price is $54.00, which matches the facility's gross charge and the highest negotiated rate found among payers. This cash price is significantly higher than the state average for this service, which is $29.00, and also exceeds the county average of $29.00. While commercial insurance plans negotiate rates ranging from $25 to $80 depending on the carrier, patients with high-deductible plans may find paying the full cash price of $54.00 more cost-effective than relying on insurance, as the negotiated rates for many plans exceed the cash amount. To potentially lower costs, patients should contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid upfront.
The facility, a Critical Access Hospital with a Proprietary ownership structure, has a Medicare benchmarking ratio of 3.6, indicating that its cash rate is 3.6 times the Medicare amount of $13.39 for this code. This markup is consistent with commercial pricing dynamics where negotiated rates often average 200% to 300% of Medicare, though fair pricing is typically defined as 120% to 150%. Patients should be aware that hospitals often issue summary bills that obscure individual line items; requesting a full itemized CPT-coded statement is essential to identify any errors, unbundled codes, or services not rendered before finalizing payment. Additionally, if a patient receives care from an out-of-network provider or