CMS Price Transparency Data

Blood test, cholesterol (lipid panel)

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 80061 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80061
Insurance Median: $158
Cash Discount Price: $202
vs. Medicare Baseline: 11.80x Medicare

The contracted insurance negotiated median rate for a Blood test, cholesterol (lipid panel) at UPMC Children's Hospital of Pittsburgh is $158. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $202. Compared to the federal Medicare reimbursement reference rate of $13.39, this hospital’s rate is 11.80x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$202

Average discount available for prompt cash payment at this facility.

Insurance Median

$158

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: $202 (1509%)

Insurance Median: $158 (1180%)

Cash: $202 (1509% of Medicare)

Ins. Median: $158 (1180% 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 1180% of the Medicare baseline (a markup of 1080%). 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	$12 - $185	90%
Health Plan Of Upper Ohio Valley	$13 - $218	97%
Amerihealth Caritas	$14 - $52	105%
Blue Cross Blue Shield	$14 - $117	105%
Cigna	$14 - $185	105%
Upmc Health Plan	$32 - $87	239%
Health Partners Plans (Jefferson Health Plan)	$54	403%
Highmark Wholecare (Prev Gateway)	$56	418%
UnitedHealthcare	$56 - $158	418%
Pa Health & Wellness	$57	426%
Geisinger	$58 - $151	433%
Intergroup	$218 - $286	1628%
Coventry/First Health	$269	2009%
Saudi Armed Forces	$269	2009%
Health Payors Organization	$286	2136%
Multiplan	$286	2136%
National Provider Network	$302	2255%
Private Health Care Systems	$302	2255%

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 $202.
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 Children's Hospital of Pittsburgh 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.