CMS Price Transparency Data

Blood test, liver function panel

Facility: Harlem Hospital Center

Billing Code: 80076 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80076
Insurance Median: $65
Cash Discount Price: Unavailable
vs. Medicare Baseline: 7.96x Medicare

The contracted insurance negotiated median rate for a Blood test, liver function panel at Harlem Hospital Center is $65. 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 $8.17, this hospital’s rate is 7.96x the Medicare baseline. Located in 506 Lenox Avenue, New York, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$65

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$8.17

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $8.17 (100%)

Insurance Median: $65 (796%)

Ins. Median: $65 (796% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $8.17 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 796% of the Medicare baseline (a markup of 696%). 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	$5 - $19	61%
Healthfirst	$5 - $147	61%
Elderplan	$8	98%
Fidelis	$8 - $147	98%
Magnacare	$10	122%
Oscar	$12	147%
Oxford	$12	147%
United	$12 - $82	147%
Centerlight	$13	159%
Wellcare	$16	196%
Carelon	$17 - $65	208%
Emblem	$19 - $88	233%
Cigna	$20	245%
Multiplan	$21	257%
Local 1199	$23	282%
Villagecare Max	$23	282%
Vnsny	$23 - $67	282%
Blue Cross Blue Shield	$27 - $147	330%
Metroplus	$62 - $147	759%
Amidacare	$65	796%
Senior Whole Health	$65	796%
United Behavioral Health	$65 - $72	796%
Affinity	$67 - $147	820%
Carelon (Amida Care)	$67	820%

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: 80076.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Harlem Hospital Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 80076.
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.