Blood test, cholesterol (lipid panel)
Facility: Morris County Hospital
Billing Code: 80061 (CPT)
- CPT Billing Code: 80061
- Insurance Median: $78
- Cash Discount Price: $120
- vs. Medicare Baseline: 5.83x 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 583% of the Medicare baseline (a markup of 483%). 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 |
|---|---|---|
| Providrs Care (Wppa)(Nexus)-All Plans | $13 | 97% |
| Aetna | $18 | 134% |
| Va Ccn-All Plans | $27 | 202% |
| Blue Cross Blue Shield | $41 - $78 | 306% |
| UnitedHealthcare | $78 - $200 | 583% |
| Choice Care Mcr Adv-All Plans | $78 | 583% |
| Coventry Mcr | $78 | 583% |
| Cigna | $145 | 1083% |
| Coventry Comm-All Other Plans | $180 | 1344% |
| Multiplan-All Plans | $180 | 1344% |
Consumer Guidance & Cost Commentary
For the blood test, cholesterol (lipid panel) procedure at Morris County Hospital in Council Grove, KS, the cash median price is $120.00, which is lower than the negotiated rates paid by most insurance carriers. While the facility's cash price is competitive, patients with high-deductible plans may find paying out-of-pocket cheaper if their insurance negotiated rate exceeds this amount. It is important to note that this facility is a Critical Access Hospital with government-local ownership, and the cash price reflects a direct payment scenario that bypasses the administrative overhead and contract structures inherent in insurance billing.
The Medicare benchmark for this service is $13.39, serving as the objective baseline for evaluating pricing markups. Commercial negotiated rates, such as the $78.00 median negotiated amount, are significantly higher than the Medicare rate, illustrating the typical markup found in commercial contracts. Because the facility is in-network for many payers, patients should be aware that balance billing is generally prohibited for emergency and non-emergency services at in-network facilities under the No Surprises Act. However, if a patient chooses to pay cash directly, they should inquire about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can further reduce the total cost compared to the standard cash median.