CMS Price Transparency Data

Blood test, cholesterol (lipid panel)

Facility: Saint Michael's Medical Center

Billing Code: 80061 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80061
Insurance Median: $14
Cash Discount Price: $13
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Blood test, cholesterol (lipid panel) at Saint Michael's Medical Center is $14. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $13. Compared to the federal Medicare reimbursement reference rate of $13.39, this hospital’s rate is 1.05x the Medicare baseline. Located in 111 Central Avenue, Newark, NJ.

Cash / Self-Pay

$13

Average discount available for prompt cash payment at this facility.

Insurance Median

$14

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: $13 (97%)

Insurance Median: $14 (105%)

Cash: $13 (97% of Medicare)

Ins. Median: $14 (105% 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
UnitedHealthcare	$8 - $13	60%
Tricare	$11	82%
Aetna	$13 - $28	97%
Amerihealth	$13	97%
Horizon	$13 - $45	97%
Humana	$13	97%
Medicare (plans)	$13	97%
New Jersey Out of State	$13	97%
Wellpoint Amerigroup	$13	97%
Clover Health	$14	105%
Curana	$14	105%
Wellcare	$14 - $18	105%
Fairprice Healthcare Holdings - Fphh	$16	119%
Cigna	$19	142%
Employer Direct Healthcare	$19	142%
Naphcare	$21	157%
Coventry	$27	202%

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 $13.
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 Saint Michael's Medical Center 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.