CMS Price Transparency Data

Blood test, cholesterol (lipid panel)

Facility: Progress West Hospital

Billing Code: 80061 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80061
Insurance Median: $62
Cash Discount Price: $57
vs. Medicare Baseline: 4.63x Medicare

The contracted insurance negotiated median rate for a Blood test, cholesterol (lipid panel) at Progress West Hospital is $62. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $57. Compared to the federal Medicare reimbursement reference rate of $13.39, this hospital’s rate is 4.63x the Medicare baseline. Located in 2 Progress Point Pkwy, Ofallon, MO.

Cash / Self-Pay

$57

Average discount available for prompt cash payment at this facility.

Insurance Median

$62

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: $57 (426%)

Insurance Median: $62 (463%)

Cash: $57 (426% of Medicare)

Ins. Median: $62 (463% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 463% of the Medicare baseline (a markup of 363%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
UnitedHealthcare	$14 - $71	105%
Healthscope Benefits [258]	$16	119%
Cigna	$18 - $29	134%
Aetna	$23 - $71	172%
Allied Benefits [498]	$23 - $71	172%
Consociate [478]	$23	172%
Coresource [497]	$23	172%
Fmh Benefit Service Inc [222]	$23	172%
Mail Handlers [495]	$23	172%
Sarah Bush Lincoln [636]	$23	172%
Apwu Health Plan [216]	$29	217%
Nalc Health Benefit Plan [242]	$29	217%
Priority Health [648]	$29	217%
Blue Cross Blue Shield	$32 - $83	239%
Humana	$37	276%
Healthlink [225]	$46 - $72	344%
Cox Health Systems Insurance Company [220]	$52 - $62	388%
Health Alliance [224]	$52	388%
Hope Trust [806]	$55	411%
Med-Pay [480]	$62 - $71	463%
Unicare [568]	$62 - $72	463%
Beechstreet [551]	$71	530%
Detego Health [868]	$71	530%
First Health Commercial [734]	$71	530%
Health Systems Inc [620]	$71	530%
Healthcare Sol Mercy [609]	$71	530%
Multiplan Commercial [737]	$71	530%
Multiplan [240]	$71	530%
Phcs [244]	$71 - $76	530%
Preferred Health Professionals [561]	$72	538%
Hfn [563]	$76	568%
Medica [661]	$76	568%
Mh Magellan Health Services [270]	$95	709%

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 $57.
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 Progress West Hospital 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.