Blood test, cholesterol (lipid panel)
Facility: Decatur Health
Billing Code: 80061 (CPT)
- CPT Billing Code: 80061
- Insurance Median: $61
- Cash Discount Price: $72
- vs. Medicare Baseline: 4.56x 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 456% of the Medicare baseline (a markup of 356%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $48 | 358% |
| UnitedHealthcare | $49 - $61 | 366% |
| Humana | $49 | 366% |
| Blue Cross Blue Shield | $56 | 418% |
| Aetna | $72 - $80 | 538% |
| Midlands Choice- All Plans | $72 | 538% |
| Medicaid / KanCare | $81 | 605% |
Consumer Guidance & Cost Commentary
For this blood test service at Decatur Health in Oberlin, Kansas, the negotiated rates paid by insurance carriers range from $48 to $81, with a median negotiated amount of $61.00. This facility is a Critical Access Hospital, and while its cash price of $72.00 is higher than the median negotiated rate, it remains comparable to the highest negotiated amounts seen among payers like Aetna. The facility's negotiated rates are significantly higher than the Medicare benchmark of $13.39, reflecting the standard administrative and contract markup inherent in commercial insurance pricing. Patients should be aware that while in-network status protects against balance billing, the actual amount paid depends heavily on whether their specific plan has met its deductible; if the deductible is not yet met, the patient may be responsible for the full negotiated rate rather than the lower cash price.
To potentially lower out-of-pocket costs, patients should verify if the facility offers a "prompt-pay" discount for upfront cash payments, which can reduce the bill by 20% to 50% by bypassing insurance claims processing fees. Since the cash price of $72.00 is already higher than the median negotiated rate of $61.00, patients with high-deductible plans might find it more economical to pay the cash price directly if the insurance allowed amount exceeds the cash rate. It is crucial to request a self-pay classification and a waiver of insurance submission before scheduling to avoid automatic claims that could void any cash discounts. Finally, if a bill is received, patients should request a full itemized audit to ensure no errors or unbundled charges are present, as over 80% of hospital bills contain discrepancies