CMS Price Transparency Data

Blood test, cholesterol (lipid panel)

Facility: Saint Thomas Highlands Hospital

Billing Code: 80061 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80061
Insurance Median: $13
Cash Discount Price: $56
vs. Medicare Baseline: 0.97x Medicare

The contracted insurance negotiated median rate for a Blood test, cholesterol (lipid panel) at Saint Thomas Highlands Hospital is $13. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $56. Compared to the federal Medicare reimbursement reference rate of $13.39, this hospital’s rate is 0.97x the Medicare baseline. Located in 401 Sewell Dr, Sparta, TN.

Cash / Self-Pay

$56

Average discount available for prompt cash payment at this facility.

Insurance Median

$13

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: $56 (418%)

Insurance Median: $13 (97%)

Cash: $56 (418% of Medicare)

Ins. Median: $13 (97% 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
Community Plan	$9 - $12	67%
Point Comfort Underwriters	$12	90%
UnitedHealthcare	$12 - $13	90%
Amerigroup Mcr Replacement	$13	97%
Ascension Complete	$13	97%
Blue Cross Blue Shield	$13 - $55	97%
Centurion Of Tn	$13	97%
Covid Uninsured Test Fund	$13	97%
Healthspring Mcr Replacement	$13	97%
Humana	$13	97%
Medicare (plans)	$13	97%
Nhc Advantage	$13	97%
Aetna	$14 - $176	105%
Ambetter / Centene	$17	127%
Cigna	$19 - $52	142%
Oscar Health	$19	142%
Smart Health	$19	142%

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 $56.
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 Thomas Highlands 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.