Blood test, cholesterol (lipid panel)
Facility: Phillips County Hospital
Billing Code: 80061 (CPT)
- CPT Billing Code: 80061
- Insurance Median: $69
- Cash Discount Price: $65
- vs. Medicare Baseline: 5.15x 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 515% of the Medicare baseline (a markup of 415%). 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 | $43 - $62 | 321% |
| UnitedHealthcare | $61 - $76 | 456% |
| Medicaid / KanCare | $76 | 568% |
| Health Partners-All Plans | $76 | 568% |
Consumer Guidance & Cost Commentary
For the CPT code 80061, representing a blood test for cholesterol, the cash median price at Phillips County Hospital in Phillipsburg, KS, is $65.00, which is lower than the facility's negotiated rate of $69.00. While the hospital is a Critical Access Hospital owned by the local government, patients should be aware that commercial insurance rates can sometimes exceed cash prices. For instance, UnitedHealthcare negotiates a rate of $61.00 to $76.00, and Blue Cross Blue Shield ranges from $43.00 to $62.00 depending on the specific plan. If you have a high-deductible plan, paying the cash price of $65.00 upfront might be more cost-effective than waiting for insurance to cover the service, especially since the lowest negotiated rate from an insurer is $43.00 but many plans may not cover this amount until the deductible is met.
When evaluating the cost of this service, it is important to compare the facility's pricing against the Medicare benchmark rather than the hospital's gross charge list. The Medicare amount for this procedure is $13.39, and the facility's cash rate of $65.00 represents a significant markup over this federal baseline. Additionally, Medicaid/KanCare and Health Partners-All Plans have a fixed negotiated rate of $76.00. To minimize out-of-pocket expenses, patients are encouraged to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the bill. Always request an itemized bill before paying to ensure all charges are accurate and to avoid unexpected balance