CMS Price Transparency Data

Blood test, cholesterol (lipid panel)

Facility: Elmhurst Hospital Center

Billing Code: 80061 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80061
Insurance Median: $51
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.81x Medicare

The contracted insurance negotiated median rate for a Blood test, cholesterol (lipid panel) at Elmhurst Hospital Center is $51. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $13.39, this hospital’s rate is 3.81x the Medicare baseline. Located in 79-01 Broadway, Elmhurst, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$51

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%)

Insurance Median: $51 (381%)

Ins. Median: $51 (381% 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 381% of the Medicare baseline (a markup of 281%). 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
Healthfirst	$6 - $114	45%
Aetna	$10 - $39	75%
Elderplan	$13	97%
Fidelis	$13 - $114	97%
Magnacare	$16	119%
Oscar	$20	149%
Oxford	$20	149%
United	$20 - $63	149%
Centerlight	$28	209%
Cigna	$33	246%
Wellcare	$34	254%
Carelon	$36 - $51	269%
Emblem	$39 - $68	291%
Blue Cross Blue Shield	$44 - $114	329%
Multiplan	$45	336%
Metroplus	$47 - $114	351%
Local 1199	$48	358%
Villagecare Max	$48	358%
Vnsny	$48 - $52	358%
Amidacare	$51	381%
Senior Whole Health	$51	381%
United Behavioral Health	$51 - $56	381%
Affinity	$52 - $114	388%
Carelon (Amida Care)	$52	388%

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 $X.
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 Elmhurst Hospital 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.