CMS Price Transparency Data

Blood test, lipase

Facility: Elmhurst Hospital Center

Billing Code: 83690 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 83690
Insurance Median: $25
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.63x Medicare

The contracted insurance negotiated median rate for a Blood test, lipase at Elmhurst Hospital Center is $25. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $6.89, this hospital’s rate is 3.63x the Medicare baseline. Located in 79-01 Broadway, Elmhurst, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$25

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%)

Insurance Median: $25 (363%)

Ins. Median: $25 (363% 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 363% of the Medicare baseline (a markup of 263%). 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	$4 - $17	58%
Healthfirst	$5 - $55	73%
Elderplan	$7	102%
Fidelis	$7 - $55	102%
Magnacare	$8	116%
Oscar	$10	145%
Oxford	$10	145%
United	$10 - $31	145%
Centerlight	$12	174%
Wellcare	$15	218%
Carelon	$16 - $25	232%
Cigna	$17	247%
Emblem	$17 - $33	247%
Multiplan	$19	276%
Local 1199	$21	305%
Villagecare Max	$21	305%
Vnsny	$21 - $25	305%
Blue Cross Blue Shield	$23 - $55	334%
Metroplus	$24 - $55	348%
Affinity	$25 - $55	363%
Amidacare	$25	363%
Carelon (Amida Care)	$25	363%
Senior Whole Health	$25	363%
United Behavioral Health	$25 - $27	363%

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 $X.
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 Elmhurst Hospital Center 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.