Blood test, cholesterol (lipid panel)
Facility: Smith County Memorial Hospital
Billing Code: 80061 (CPT)
- CPT Billing Code: 80061
- Insurance Median: $61
- Cash Discount Price: $65
- 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 |
|---|---|---|
| Blue Cross Blue Shield | $43 | 321% |
| Medicaid / KanCare | $46 - $65 | 344% |
| Multiplan-All Plans | $58 | 433% |
| Wppa-All Plans | $61 | 456% |
| Health Partners Of Ks Ppo-All Plans | $62 | 463% |
| Midlands Choice-All Plans | $62 | 463% |
| UnitedHealthcare | $62 | 463% |
Consumer Guidance & Cost Commentary
For the CPT code 80061, representing a blood test for cholesterol, Smith County Memorial Hospital in Smith Center, KS, lists a gross charge of $65.00. This amount aligns exactly with the facility's cash median and Medicare benchmark of $13.39, indicating a markup of 4.6 times the federal rate. While Medicaid/KanCare plans negotiate a range between $46 and $65, the facility's median negotiated rate across all payers is $61.00. It is important to note that for patients with high-deductible plans, paying the cash price of $65.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash price due to administrative overheads.
Patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling services, as these upfront payment incentives can significantly reduce the final bill by bypassing costly claims processing. Although the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, patients should still review their itemized bills to ensure no unbundled codes or services not rendered are included. Given that over 80% of hospital bills contain errors, requesting a detailed, line-by-line statement is essential to identify any discrepancies before payment.