CMS Price Transparency Data

Blood test, cholesterol (lipid panel)

Facility: South Pointe Hospital

Billing Code: 80061 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80061
Insurance Median: $33
Cash Discount Price: $57
vs. Medicare Baseline: 2.46x Medicare

The contracted insurance negotiated median rate for a Blood test, cholesterol (lipid panel) at South Pointe Hospital is $33. 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 2.46x the Medicare baseline. Located in 20000 Harvard Road, Warrensville Heights, OH.

Cash / Self-Pay

$57

Average discount available for prompt cash payment at this facility.

Insurance Median

$33

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: $33 (246%)

Cash: $57 (426% of Medicare)

Ins. Median: $33 (246% 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 246% of the Medicare baseline (a markup of 146%). 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
Aetna	$13 - $87	97%
Humana	$13 - $74	97%
Summacare	$13 - $33	97%
The Health Plan	$13 - $52	97%
United	$13 - $20	97%
UnitedHealthcare	$13 - $54	97%
Upmc	$13 - $52	97%
Valor	$13	97%
Cigna	$14 - $70	105%
Communicare	$14	105%
Perennial Health	$14	105%
Cc Ehp	$15 - $35	112%
Mmo	$16 - $52	119%
Paramount	$19	142%
Blue Cross Blue Shield	$20 - $56	149%
Buckeye	$20	149%
Caresource	$20	149%
Molina	$20	149%
Amerihealth	$21	157%
Oscar	$26 - $33	194%
Aultcare	$37	276%
Ohcp	$42	314%
Omas	$44	329%
Ohio Healthy	$47	351%
Healthsmart	$48	358%
Php	$52	388%
Gms	$61	456%
Medical Benefit Corp	$61	456%
Quality Care Partners	$61	456%
Consociate Health	$65	485%
Frontpath	$78	583%
Managed Care Services	$78	583%
Multiplan	$78	583%
Tertiary Care Network	$78	583%
Three Rivers	$78	583%

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 South Pointe 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.