Blood test, cholesterol (lipid panel)
Facility: Hiawatha Community Hospital
Billing Code: 80061 (CPT)
- CPT Billing Code: 80061
- Insurance Median: $104
- Cash Discount Price: $134
- vs. Medicare Baseline: 7.77x 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 777% of the Medicare baseline (a markup of 677%). 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 | $41 - $43 | 306% |
| Humana | $50 | 373% |
| UnitedHealthcare | $50 - $115 | 373% |
| Aetna | $50 - $108 | 373% |
| Ambetter / Centene | $60 | 448% |
| Oscar - All Plans | $100 | 747% |
| Centrus Health Direct - All Plans | $100 | 747% |
| Preferred Hlth - All Plans | $121 | 904% |
| Cigna | $127 | 948% |
| Wppa Providrs Care - All Plans | $127 | 948% |
| Midlands Choice - All Plans | $130 | 971% |
| Multiplan - All Plans | $130 | 971% |
| Healthy Blue Mcaid - All Plans | $134 | 1001% |
Consumer Guidance & Cost Commentary
For the blood test, cholesterol (lipid panel) procedure at Hiawatha Community Hospital, the cash price is $134.00, which matches the facility's gross charge and the state average. While the hospital's negotiated rates with major payers like Blue Cross Blue Shield and Humana range from $41 to $50, these amounts are significantly lower than the cash price, suggesting that for patients with high-deductible plans, paying the cash rate might result in higher out-of-pocket costs if the insurance allowed amount exceeds the cash price. It is important to note that while the facility is a Critical Access Hospital in Kansas, the cash price remains consistent with the gross charge, and patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling to potentially reduce the final amount owed.
The Medicare benchmark for this service is $13.39, indicating that the cash price of $134.00 represents a substantial markup compared to the federal baseline. Although the median negotiated rate across payers is $104.00, which is lower than the cash price, patients should be aware that commercial rates often include administrative overhead and do not necessarily reflect the true cost of care. To avoid unexpected balance billing or errors, consumers should request a full itemized bill before paying and ensure they understand their deductible status, as paying the cash price upfront may bypass insurance processing delays but could still be higher than the actual allowed amount depending on the specific plan.