CMS Price Transparency Data

Blood test, cholesterol (lipid panel)

Facility: UPMC Kane

Billing Code: 80061 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80061
Insurance Median: $60
Cash Discount Price: $95
vs. Medicare Baseline: 4.48x Medicare

The contracted insurance negotiated median rate for a Blood test, cholesterol (lipid panel) at UPMC Kane is $60. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $95. Compared to the federal Medicare reimbursement reference rate of $13.39, this hospital’s rate is 4.48x the Medicare baseline. Located in 4372 Route 6, Kane, PA.

Cash / Self-Pay

$95

Average discount available for prompt cash payment at this facility.

Insurance Median

$60

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: $95 (709%)

Insurance Median: $60 (448%)

Cash: $95 (709% of Medicare)

Ins. Median: $60 (448% 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 448% of the Medicare baseline (a markup of 348%). 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
UPMC Work Partners	$13	97%
UPMC Health Plan	$15 - $69	112%
Focus Healthcare	$15 - $150	112%
Aetna	$15 - $61	112%
UnitedHealthcare	$16 - $64	119%
Geisinger	$19	142%
Highmark Wholecare (Prev Gateway)	$21 - $60	157%
Amerihealth Caritas	$22 - $63	164%
PA Health & Wellness	$24	179%
Blue Cross Blue Shield	$58 - $71	433%
Horizon Health Plan	$111	829%
Cigna	$111 - $3,557	829%
Multiplan	$118	881%
Health Coalition Partners	$126	941%
Intergroup	$126	941%

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 $95.
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 Kane 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.