CMS Price Transparency Data

Blood test, liver function panel

Facility: UPMC Pinnacle Hospitals

Billing Code: 80076 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80076
Insurance Median: $48
Cash Discount Price: $50
vs. Medicare Baseline: 5.88x Medicare

The contracted insurance negotiated median rate for a Blood test, liver function panel at UPMC Pinnacle Hospitals is $48. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $50. Compared to the federal Medicare reimbursement reference rate of $8.17, this hospital’s rate is 5.88x the Medicare baseline. Located in 409 South Second Street, Harrisburg, PA.

Cash / Self-Pay

$50

Average discount available for prompt cash payment at this facility.

Insurance Median

$48

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%)

Cash / Self-Pay: $50 (612%)

Insurance Median: $48 (588%)

Cash: $50 (612% of Medicare)

Ins. Median: $48 (588% 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 588% of the Medicare baseline (a markup of 488%). 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	$8 - $87	98%
Humana	$8	98%
Upmc Work Partners	$8	98%
Aetna	$9 - $66	110%
Amerihealth Caritas	$9	110%
Cigna	$9	110%
Pa Health & Wellness	$9 - $15	110%
UnitedHealthcare	$9 - $12	110%
Health Partners Plans (Jefferson Health Plan)	$12	147%
Geisinger	$13	159%
Keystone Health Plan	$15 - $48	184%
Prime Net	$18 - $68	220%
Intergroup	$49 - $76	600%
Upmc Health Plan	$55	673%
Wellspan Population Health	$64 - $76	783%

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 $50.
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 UPMC Pinnacle Hospitals 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.