CMS Price Transparency Data

Blood test, cholesterol (lipid panel)

Facility: Adena Pike Medical Center

Billing Code: 80061 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80061
Insurance Median: $53
Cash Discount Price: $35
vs. Medicare Baseline: 3.96x Medicare

The contracted insurance negotiated median rate for a Blood test, cholesterol (lipid panel) at Adena Pike Medical Center is $53. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $35. Compared to the federal Medicare reimbursement reference rate of $13.39, this hospital’s rate is 3.96x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$35

Average discount available for prompt cash payment at this facility.

Insurance Median

$53

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: $35 (261%)

Insurance Median: $53 (396%)

Cash: $35 (261% of Medicare)

Ins. Median: $53 (396% 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 396% of the Medicare baseline (a markup of 296%). 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	$17 - $96	127%
Blue Cross Blue Shield	$17 - $60	127%
Buckeye Community Health Plan	$17	127%
Care Source	$17	127%
Humana	$17 - $66	127%
Medical Mutual Of Ohio	$17 - $44	127%
Medigold	$17	127%
Molina	$17	127%
Gateway Health	$23	172%
Molina Marketplace	$27	202%
Care Source Just4Me	$30	224%
Sidecar Health	$46	344%
Ohio Ppo Connect	$49	366%
The Health Plan	$49	366%
Cigna	$51	381%
Medical Mutual Of Ohio Supermed	$53	396%
First Health	$55 - $96	411%
Ohio Health Choice	$56	418%
Healthsmart	$66	493%
Integrated Health Plan	$66	493%
Multiplan/Private Healthcare Systems	$66	493%
Three Rivers Network	$66	493%
UnitedHealthcare	$80	597%

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 $35.
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 Adena Pike 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.