CMS Price Transparency Data

Blood test, lipase

Facility: Hermann Area District Hospital

Billing Code: 83690 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 83690
Insurance Median: $47
Cash Discount Price: $48
vs. Medicare Baseline: 6.82x Medicare

The contracted insurance negotiated median rate for a Blood test, lipase at Hermann Area District Hospital is $47. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $48. Compared to the federal Medicare reimbursement reference rate of $6.89, this hospital’s rate is 6.82x the Medicare baseline. Located in 509 W 18Th St, Hermann, MO.

Cash / Self-Pay

$48

Average discount available for prompt cash payment at this facility.

Insurance Median

$47

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: $48 (697%)

Insurance Median: $47 (682%)

Cash: $48 (697% of Medicare)

Ins. Median: $47 (682% 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 682% of the Medicare baseline (a markup of 582%). 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
Coventry - All Plans	$6	87%
UnitedHealthcare	$10 - $34	145%
Tricare	$32	464%
Cigna	$33	479%
Choicecare Mcr Adv- All Plans	$34	493%
American Hlth Mcr Adv- All Plans	$35	508%
Blue Cross Blue Shield	$35 - $66	508%
Humana	$35	508%
Aetna	$36 - $76	522%
Wellcare Mcr Adv - All Plans	$36	522%
Harmony Hp Mcaid- All Plans	$47	682%
Healthcare Usa Mcaid- All Plans	$52	755%
Healthlink Hmo	$52	755%
Ambetter / Centene	$57	827%
Healthlink Ppo - All Other Plans	$60	871%
Multiplan/Phcs - All Plans	$60	871%
Comp Results - All Plans	$72	1045%
Three Rivers - All Plans	$72	1045%
Care Partners Mcaid- All Plans	$80	1161%

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 $48.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 83690.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Hermann Area District Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 83690.
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.