Blood test, cholesterol (lipid panel)
Facility: Clay County Medical Center
Billing Code: 80061 (CPT)
- CPT Billing Code: 80061
- Insurance Median: $90
- Cash Discount Price: $94
- vs. Medicare Baseline: 6.72x 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 672% of the Medicare baseline (a markup of 572%). 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 |
|---|---|---|
| Aetna | $88 | 657% |
| Wppa/Providrs Care- All Plans | $88 | 657% |
| Health Partners - All Plans | $90 | 672% |
| UnitedHealthcare | $90 | 672% |
| Multiplan- All Plans | $90 | 672% |
Consumer Guidance & Cost Commentary
For a blood test, cholesterol (lipid panel) at Clay County Medical Center in Clay Center, KS, the cash median price is $94.00, which matches the facility's gross charge. This cash rate is significantly higher than the state average of $88.00, meaning paying out-of-pocket directly is currently more expensive than the typical negotiated rate for this service in Kansas. However, for patients with high-deductible plans, the cash price of $94.00 may still be the most affordable option if the insurance negotiated rate exceeds this amount. Since the facility is a Critical Access Hospital with government local ownership, patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by bypassing administrative claim processing fees.
The facility's negotiated rates for this procedure range from $88.00 to $90.00 across five payers, including Aetna, UnitedHealthcare, and Health Partners, which are lower than the cash price but may still require significant patient cost-sharing depending on individual plan deductibles. When comparing these rates to the Medicare benchmark of $13.39, the commercial negotiated rates represent a substantial markup, highlighting the difference between federal cost-based reimbursement and private insurance contracts. To ensure you are receiving the best possible price, it is recommended to request an itemized billing audit to verify that no unbundled codes or services not rendered are included in the final invoice, as over 80% of hospital bills contain errors that can be corrected through formal written disputes.