CMS Price Transparency Data

Blood test, lipase

Facility: Sonoma Valley Hospital

Billing Code: 83690 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 83690
  • Insurance Median: $84
  • Cash Discount Price: $279
  • vs. Medicare Baseline: 12.19x Medicare
The contracted insurance negotiated median rate for a Blood test, lipase at Sonoma Valley Hospital is $84. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $279. Compared to the federal Medicare reimbursement reference rate of $6.89, this hospital’s rate is 12.19x the Medicare baseline. Located in 347 Andrieux St, Sonoma, CA.
Cash / Self-Pay
$279

Average discount available for prompt cash payment at this facility.

Insurance Median
$84

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$6.89

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $6.89 (100%)
Cash / Self-Pay: $279 (4049%)
Insurance Median: $84 (1219%)
Cash: $279 (4049% of Medicare)
Ins. Median: $84 (1219% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $6.89 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 1219% of the Medicare baseline (a markup of 1119%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

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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 $7 - $399 102%
Bright Hlth/Brand New Day Mcr Adv $7 102%
Hospice Of Marin-All Plans $7 102%
Marin General Comm/Mcr Adv (Western Hlth)-All Plan $7 102%
St Joseph Heritage Hltcare Comm-All Other Plans $7 102%
Tricare $7 102%
Veterans Admin-All Plans $7 102%
Cdcr Prison-All Plans $8 116%
Medi-Cal $8 116%
Partnership Healthplan-All Plans $8 116%
Three Rivers (Trpn)-All Plans $8 116%
Bright Hlth/Brand New Day - All Other Plands $9 131%
Chp - Correctional Health Partners - All Plans $9 131%
Wellpath - All Plans $10 145%
Aetna $11 160%
First Health(Coventry)-All Plans $11 160%
Canopy Bay Area Accountable Care Ntwrk (Baacn) - A $12 174%
Canopy Health Solutions-All Other Plans $12 174%
Mcal Mgd Care (Php)-All Plans $13 189%
UnitedHealthcare $14 203%
Meritage Medical Network Op Only Mcare $27 392%
Meritage Medical Network Op Only-All Other Plans $27 392%
Healthnet Hmo/Ppo-All Other Plans $140 2032%
Blue Shield Ppo-All Plans $227 3295%
Kaiser-All Plans $259 3759%
Integrated Health Plan-All Plans $295 4282%
Champus-All Plans $319 4630%
Cigna $319 4630%
Networks By Design - All Plans $319 4630%
Comm Care Network(Ccn)-All Plans $339 4920%
Great West-One Health Plan Ppo/Pos-All Plans $339 4920%
Phcs/Multiplan/Beech St-All Plans $339 4920%
Interplan-All Plans $351 5094%
Bps-All Plans $359 5210%
Ppo Alliance-All Plans $359 5210%
Pref Health Networl(Phn)-All Plans $359 5210%
Scan Mcare-All Plans $399 5791%
St Joseph Heritage Hltcare Mcr Adv $399 5791%
Correct Care Integ Health-All Plans $479 6952%
Employer Direct Healthcare-All Plans $479 6952%
Creative Legal Services-All Plans $519 7533%
Canopy Op Only $718 10421%
Vnpn - All Plans $718 10421%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 347 Andrieux St, Sonoma, CA 95476
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Acute Care Hospitals