Blood test, cholesterol (lipid panel)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 80061 (CPT)
- CPT Billing Code: 80061
- Insurance Median: $54
- Cash Discount Price: $56
- vs. Medicare Baseline: 4.03x 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 403% of the Medicare baseline (a markup of 303%). 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 |
|---|---|---|
| Tricare | $45 | 336% |
| Humana | $51 | 381% |
| Aetna | $52 - $56 | 388% |
| Hpk-All Plans | $54 | 403% |
| UnitedHealthcare | $54 | 403% |
| Medicaid / KanCare | $56 | 418% |
Consumer Guidance & Cost Commentary
For the blood test, cholesterol (lipid panel) service at Medicine Lodge Memorial Hospital, the cash price is $56.00, which matches the facility's negotiated rate for most payers. This cash price is significantly higher than the Medicare benchmark of $13.39, reflecting the typical markup found in commercial billing. While the facility is a Critical Access Hospital in Medicine Lodge, KS, the data does not provide specific county or state average comparisons for this code, so patients should rely on the Medicare rate as a baseline for fair pricing. Because the cash price equals the negotiated rate for many insurers, patients with high-deductible plans might find paying out-of-pocket at $56.00 cheaper than facing a negotiated rate that exceeds their deductible threshold.
Patients should verify their specific plan details before scheduling, as commercial negotiated rates can sometimes exceed cash prices depending on the insurance carrier. For instance, while Tricare and Hpk-All Plans have a fixed negotiated rate of $45.00 and $54.00 respectively, Aetna plans range from $52.00 to $56.00, and Humana is set at $51.00. If your insurance allows a higher allowed amount than the cash price, paying self-pay could save you money. Additionally, since the facility is a Government-owned Hospital District, you may be eligible for prompt-pay discounts if you settle the bill upfront, though these must be requested before check-in to avoid automatic insurance submission. Always ask for a self-pay classification and a waiver of insurance submission to ensure you receive the lowest possible rate for this service.