Blood test, cholesterol (lipid panel)
Facility: Kiowa District Hospital
Billing Code: 80061 (CPT)
- CPT Billing Code: 80061
- Insurance Median: $80
- Cash Discount Price: $68
- vs. Medicare Baseline: 5.97x 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 597% of the Medicare baseline (a markup of 497%). 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 |
|---|---|---|
| Healthchoice-All Plans | $20 | 149% |
| Tricare | $33 | 246% |
| Blue Cross Blue Shield | $43 | 321% |
| UnitedHealthcare | $68 - $85 | 508% |
| Health Partners Of Ks-All Plans | $75 | 560% |
| Humana | $77 | 575% |
| Multiplan-All Plans | $80 | 597% |
| Gbs Insurance - All Plans | $80 | 597% |
| Triwest-All Plans | $81 | 605% |
| Aetna | $81 | 605% |
| Medicare (plans) | $81 | 605% |
| Medicaid / KanCare | $85 | 635% |
| Providers Care (Wppa)-All Plans | $128 | 956% |
| Liberty Healthshare-All Plans | $137 | 1023% |
Consumer Guidance & Cost Commentary
For the blood test, cholesterol (lipid panel) procedure at Kiowa District Hospital, the cash median price is $68.00, which is lower than the negotiated rates of $80.00 paid by most insurance payers. While commercial insurance contracts often result in higher allowed amounts due to administrative costs and contract dynamics, patients with high-deductible plans may find paying the cash price directly more cost-effective if their insurance negotiated rate exceeds the cash fee. It is important to note that the facility, a Critical Access Hospital in Kiowa, KS, does not list a specific county or state average for this procedure in the provided data; however, patients should always verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront payment incentives can further reduce the final bill by bypassing costly insurance billing cycles.
The Medicare benchmark for this service is $13.39, which serves as the objective baseline for evaluating pricing markups, as commercial rates often range significantly higher due to provider cost structures and administrative overhead. Although the facility is government-owned, the negotiated rates of $80.00 reflect standard commercial contract ceilings rather than the federal cost basis. Consumers should be aware that hospitals may issue summary bills obscuring individual charges, so requesting a detailed itemized statement is crucial to identifying any unbundled codes or services not rendered. Additionally, under the No Surprises Act, patients are protected from balance billing for out-of-network services at in-network facilities, ensuring that the final amount owed aligns with the negotiated or cash rates rather than inflated chargemaster prices.