CMS Price Transparency Data

Blood test, cholesterol (lipid panel)

Facility: UPMC Pinnacle Hospitals

Billing Code: 80061 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80061
Insurance Median: $78
Cash Discount Price: $83
vs. Medicare Baseline: 5.83x Medicare

The contracted insurance negotiated median rate for a Blood test, cholesterol (lipid panel) at UPMC Pinnacle Hospitals is $78. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $83. Compared to the federal Medicare reimbursement reference rate of $13.39, this hospital’s rate is 5.83x the Medicare baseline. Located in 409 South Second Street, Harrisburg, PA.

Cash / Self-Pay

$83

Average discount available for prompt cash payment at this facility.

Insurance Median

$78

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: $83 (620%)

Insurance Median: $78 (583%)

Cash: $83 (620% of Medicare)

Ins. Median: $78 (583% 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 583% of the Medicare baseline (a markup of 483%). 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
Blue Cross Blue Shield	$13 - $109	97%
Aetna	$14 - $107	105%
Amerihealth Caritas	$14	105%
Cigna	$14	105%
Humana	$14	105%
Pa Health & Wellness	$14 - $24	105%
UnitedHealthcare	$14 - $18	105%
Upmc Work Partners	$14	105%
Health Partners Plans (Jefferson Health Plan)	$19	142%
Geisinger	$20	149%
Keystone Health Plan	$26 - $78	194%
Prime Net	$31 - $110	232%
Upmc Health Plan	$70	523%
Intergroup	$84 - $124	627%
Wellspan Population Health	$110 - $124	822%

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 $83.
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 UPMC Pinnacle Hospitals 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.