CMS Price Transparency Data

Blood test, cholesterol (lipid panel)

Facility: Southcoast Hospitals Group

Billing Code: 80061 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80061
Insurance Median: $16
Cash Discount Price: $105
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Blood test, cholesterol (lipid panel) at Southcoast Hospitals Group is $16. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $105. Compared to the federal Medicare reimbursement reference rate of $13.39, this hospital’s rate is 1.19x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$105

Average discount available for prompt cash payment at this facility.

Insurance Median

$16

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$13.39

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $13.39 (100%)

Cash / Self-Pay: $105 (784%)

Insurance Median: $16 (119%)

Cash: $105 (784% of Medicare)

Ins. Median: $16 (119% of 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$13 - $160	97%
Blue Cross Blue Shield	$13 - $27	97%
Evercare [1010304]	$13	97%
Medicare (plans)	$13 - $52	97%
Tufts Senior Care Options [1010315]	$13	97%
UnitedHealthcare	$13 - $16	97%
Commonwealth Care Alliance [1080501]	$14	105%
Wellsense Health Plan Senior Care Options [1020208	$14	105%
Eternal Health [1010322]	$15	112%
Tufts Health Public Plans [1010213]	$16	119%
Fallon [1000114]	$19	142%
Cigna	$30	224%
Harvard Pilgrim [1010602]	$31	232%
Wellpoint [1000102]	$42	314%
Wellsense Health Plan Clarity Connectorcare & Meta	$45	336%
Tufts [1010701]	$88	657%
Mass General Brigham Health Plan Commercial [10122	$118	881%
Mass General Brigham Health Plan Connectorcare [10	$118	881%
Group Insurance Service Center [1013001]	$126	941%
Innovative Health Plan [1025001]	$126	941%
Priority Health [1015001]	$126	941%
PHCS [1000125]	$136	1016%
First Health [1000130]	$160	1195%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $105.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 80061.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Southcoast Hospitals Group is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 80061.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.