Blood test, cholesterol (lipid panel)
Facility: Children'S Mercy South
Billing Code: 80061 (CPT)
- CPT Billing Code: 80061
- Insurance Median: $102
- Cash Discount Price: $75
- vs. Medicare Baseline: 7.62x 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 762% of the Medicare baseline (a markup of 662%). 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 | $12 - $106 | 90% |
| Healthy Blue | $15 - $37 | 112% |
| Medicaid / KanCare | $16 | 119% |
| Home State Health | $32 | 239% |
| Blue Cross Blue Shield | $64 - $116 | 478% |
| Cigna | $75 - $109 | 560% |
| Medica | $92 | 687% |
| Aetna | $94 - $107 | 702% |
| Centivo | $102 | 762% |
| Quiktrip | $102 | 762% |
| Nebraska Furniture Mart | $102 | 762% |
| Health Midwest Comprehensive Care | $102 | 762% |
| Wellfit/Centrus | $102 | 762% |
| Wppa Providrs Care | $102 | 762% |
| Orscheln | $102 | 762% |
| Humana | $104 | 777% |
| Coxhealth Network | $116 | 866% |
| Coventry Health Care Of Kansas | $116 | 866% |
| Mercy Health | $118 | 881% |
| Multiplan | $119 | 889% |
| American Healthcare Alliance | $133 | 993% |
| Healthlink | $138 | 1031% |
| National Preferred Provider Network | $141 | 1053% |
Consumer Guidance & Cost Commentary
For the blood test, cholesterol (lipid panel) procedure at Children's Mercy South in Overland Park, KS, the facility's cash median rate of $75.00 is significantly lower than the state average of $157.00. While many commercial payers have negotiated rates ranging from $12 to $141, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to note that while the No Surprises Act protects patients from balance billing for emergency services and non-emergency out-of-network care at in-network facilities, unexpected ancillary services or out-of-network providers could still trigger additional charges. Patients should verify their specific plan details and ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the administrative costs associated with insurance claims processing.
The facility's negotiated rates vary widely across different insurance carriers, with the lowest allowed amount being $12 and the highest reaching $141, while the median negotiated rate across all payers is $102.00. When evaluating these commercial rates, it is more accurate to compare them against the Medicare benchmark of $13.39 rather than the facility's gross chargemaster price of $157.00, as Medicare rates represent the true cost baseline for healthcare delivery. Although the facility is a voluntary non-profit, the administrative load of insurance billing can inflate rates by 20% to 40% compared to direct cash payments. To ensure accuracy, patients should request a full itemized CPT-coded bill before paying, as summary bills may obscure unbund