Blood test, cholesterol (lipid panel)
Facility: Fredonia Regional Hospital
Billing Code: 80061 (CPT)
- CPT Billing Code: 80061
- Insurance Median: $75
- Cash Discount Price: $83
- vs. Medicare Baseline: 5.60x 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 560% of the Medicare baseline (a markup of 460%). 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 |
|---|---|---|
| UnitedHealthcare | $11 - $75 | 82% |
| Blue Cross Blue Shield | $41 - $43 | 306% |
| Veterans Programs - All Plans | $42 | 314% |
| Aetna | $42 - $75 | 314% |
| Reserve National-All Plans | $75 | 560% |
| Cigna | $75 | 560% |
| Meritain-All Plans | $75 | 560% |
Consumer Guidance & Cost Commentary
For the CPT code 80061, representing a blood test for cholesterol (lipid panel), the cash median price at Fredonia Regional Hospital in Fredonia, KS is $83.00. This cash rate is significantly higher than the state average of $50.00, though it remains consistent with the facility's own cash median. While the facility is a Critical Access Hospital owned by the local government, patients with high-deductible plans may find paying the cash price directly more cost-effective than using insurance, as the negotiated rates paid by commercial payers often exceed the cash amount. For instance, UnitedHealthcare's negotiated rate range spans from $11 to $75, and Aetna's range is $42 to $75, meaning the cash price of $83 could be lower than the final out-of-pocket cost for some members.
To ensure you receive the best possible rate, it is crucial to request an itemized billing audit before finalizing payment, as summary bills can obscure individual charges and potential errors. Additionally, you should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront, bypassing the administrative costs associated with insurance claims. When comparing prices, always benchmark against the Medicare amount of $13.39 rather than the facility's gross charge of $83.00, as commercial negotiated rates often include administrative markups that do not reflect the true cost of care. Finally, verify your deductible status before scheduling, as using insurance without meeting your deductible could result in paying the full negotiated rate rather than just your out-of-pocket maximum