CMS Price Transparency Data
Blood test, lipase
Facility: Saint Alphonsus Medical Center Ontario
Billing Code: 83690 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 83690
- Insurance Median: $38
- Cash Discount Price: $77
- vs. Medicare Baseline: 5.52x Medicare
The contracted insurance negotiated median rate for a Blood test, lipase at Saint Alphonsus Medical Center Ontario is $38. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $77. Compared to the federal Medicare reimbursement reference rate of $6.89, this hospital’s rate is 5.52x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.
Cash / Self-Pay
$77
Average discount available for prompt cash payment at this facility.
Insurance Median
$38
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: $77 (1118%)
Insurance Median: $38 (552%)
Cash: $77 (1118% of Medicare)
Ins. Median: $38 (552% 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 552% of the Medicare baseline (a markup of 452%). 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.
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 |
|---|---|---|
| Medicaid / KanCare | $5 - $38 | 73% |
| Aetna | $7 - $120 | 102% |
| American Health Advantage Of Idaho | $7 | 102% |
| Blue Cross Blue Shield | $7 - $108 | 102% |
| Healthnet | $7 | 102% |
| Medicare (plans) | $7 | 102% |
| UnitedHealthcare | $7 - $122 | 102% |
| Blue Benefit Administrators Of Massachusetts | $12 | 174% |
| Blue Care Network | $12 | 174% |
| Blue Distinction Transplant | $12 | 174% |
| Blue Shield - Ca | $12 | 174% |
| Blue Shield - Id (Regence) | $12 | 174% |
| Blue Shield - Ny Highmark Northeastern | $12 | 174% |
| Blue Shield - Ny Highmark Western | $12 | 174% |
| Blue Shield - Pa (Highmark) | $12 | 174% |
| Blue Shield - Wa (Regence) | $12 | 174% |
| Healthcare Management Admin | $12 | 174% |
| Moda Health | $13 - $123 | 189% |
| Webtpa | $18 - $114 | 261% |
| Selecthealth | $26 - $114 | 377% |
| Ada County Jail Inmate Ins | $33 - $38 | 479% |
| Ambetter / Centene | $33 - $38 | 479% |
| Amish Mennonite | $33 - $38 | 479% |
| Bcccp-Michigan | $33 - $38 | 479% |
| Bccp | $33 - $38 | 479% |
| Bmc Healthnet | $33 - $38 | 479% |
| Breast Grant-Connecticut | $33 - $38 | 479% |
| California Health And Wellness | $33 - $38 | 479% |
| Cardinal Innovations Lme | $33 - $38 | 479% |
| Care Oregon Ohp | $33 - $38 | 479% |
| Cencal Health Plan | $33 - $38 | 479% |
| Cenpatico | $33 - $38 | 479% |
| Centurion Of Idaho | $33 - $38 | 479% |
| Chhuny | $33 - $38 | 479% |
| Childrens Comm Health Plan | $33 - $38 | 479% |
| Childrens Medical Services Title 19 | $33 - $38 | 479% |
| Cigna | $33 - $119 | 479% |
| Community Benefit Health | $33 - $38 | 479% |
| Community Care Behavorial Health | $33 - $38 | 479% |
| Community Health Choice | $33 - $38 | 479% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $33 - $38 | 479% |
| Dean Wi Badgercare | $33 - $38 | 479% |
| Delaware First Health | $33 - $38 | 479% |
| Delta Dental Nj | $33 - $38 | 479% |
| Dph Tb Program | $33 - $38 | 479% |
| Dscc | $33 - $38 | 479% |
| Eastpointe Lme | $33 - $38 | 479% |
| Family Health Network | $33 - $38 | 479% |
| Freedom First Healthcare | $33 - $38 | 479% |
| Ghc Scw Wi Badgercare | $33 - $38 | 479% |
| Harbor Health | $33 - $38 | 479% |
| Health Safety Net | $33 - $38 | 479% |
| Healthy Blue Ne | $33 - $38 | 479% |
| Hennepin Health | $33 - $38 | 479% |
| Humana | $33 - $112 | 479% |
| Id County Ada | $33 - $38 | 479% |
| Id County Canyon | $33 - $38 | 479% |
| Id County Cat Fund | $33 - $38 | 479% |
| Id County Payette | $33 - $38 | 479% |
| Idaho Womens Health Check | $33 - $38 | 479% |
| Indiana Breast Cervical Cancer | $33 - $38 | 479% |
| Inland Empire Health Plan | $33 - $38 | 479% |
| Intercommunity Health Ohp | $33 - $38 | 479% |
| Iowa Total Care | $33 - $38 | 479% |
| Jai Medical System | $33 - $38 | 479% |
| Kern Family Health Plan | $33 - $38 | 479% |
| Keystone First | $33 - $38 | 479% |
| Keystone First Chip | $33 - $38 | 479% |
| La Care Health Plan | $33 - $38 | 479% |
| Lakeland Care Inc | $33 - $38 | 479% |
| Managed Health Services - Indiana | $33 - $38 | 479% |
| Maryland Breast & Cervical Program | $33 - $38 | 479% |
| Maryland Healthy Smiles - Scion Dental | $33 - $38 | 479% |
| Maryland Physicians Care | $33 - $38 | 479% |
| Massachusetts Behavioral Health Partnership | $33 - $38 | 479% |
| Mdwise | $33 - $38 | 479% |
| Medi-Cal | $33 - $38 | 479% |
| Medi-Cal Healthnet | $33 - $38 | 479% |
| Medstar Dc Healthy Family | $33 - $38 | 479% |
| Medstar Md Health Choice | $33 - $38 | 479% |
| Mo Home State Health Plan | $33 - $38 | 479% |
| Molina Centennial Care | $33 - $38 | 479% |
| Nascentia Health Options | $33 - $38 | 479% |
| Nebraska Total Care | $33 - $38 | 479% |
| New York Cancer Services Program | $33 - $38 | 479% |
| Nextlevel Health | $33 - $38 | 479% |
| Oregon Screenwise | $33 - $38 | 479% |
| Pace Of Southwest Michigan | $33 - $38 | 479% |
| Paramount Advantage | $33 - $38 | 479% |
| Parkland Community Health Plan | $33 - $38 | 479% |
| Partners Behavioral Lme | $33 - $38 | 479% |
| Peach State Healthplan | $33 - $38 | 479% |
| Presbyterian Centennial Care | $33 - $38 | 479% |
| Prestige Health Choice | $33 - $38 | 479% |
| Priority Partners | $33 - $38 | 479% |
| Rx 340B Pass Along | $33 - $38 | 479% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $33 - $38 | 479% |
| Rx Medi-Cal | $33 - $38 | 479% |
| Rx Meridian Rx | $33 - $38 | 479% |
| Sandhills Center Lme | $33 - $38 | 479% |
| Screening For Life | $33 - $38 | 479% |
| Sunshine State Health Plan | $33 - $38 | 479% |
| Superior Health | $33 - $38 | 479% |
| Tenncare | $33 - $38 | 479% |
| Texas Children'S Health Plan | $33 - $38 | 479% |
| Trillium Community Ohp | $33 - $38 | 479% |
| Tufts Health Public Plans | $33 - $38 | 479% |
| Vaya Health Lme | $33 - $38 | 479% |
| Wellsense Health Plan | $33 - $38 | 479% |
| Wi Womens Wellness | $33 - $38 | 479% |
| Mountain Health Co-Op | $65 - $76 | 943% |
| Pacificsource Health Plans | $65 - $119 | 943% |
| Allegiance | $83 - $97 | 1205% |
| Correctional Health Partners | $85 - $99 | 1234% |
| Columbia Health Network | $87 - $102 | 1263% |
| Allied National Global Care | $98 - $114 | 1422% |
| Asrm - Reliance Standard Life Insurance | $98 - $114 | 1422% |
| Christian Care Ministry | $98 - $114 | 1422% |
| Dean Health | $98 - $114 | 1422% |
| Fallon Health | $98 - $114 | 1422% |
| Family Life Insurance Company | $98 - $114 | 1422% |
| First Choice Health | $98 - $114 | 1422% |
| Ghc Scw | $98 - $114 | 1422% |
| International Benefit Administrators | $98 - $114 | 1422% |
| Lifetime Benefit Solutions | $98 - $114 | 1422% |
| Manhattan Life | $98 - $114 | 1422% |
| Pai | $98 - $114 | 1422% |
| Pan-American Life | $98 - $114 | 1422% |
| Paramount Hmo | $98 - $114 | 1422% |
| Phcs | $98 - $114 | 1422% |
| Trinity Health Share | $98 - $114 | 1422% |
| Lifewise | $101 - $118 | 1466% |
| Priority Health | $102 - $119 | 1480% |
| Allied Benefit Systems | $103 - $120 | 1495% |
| Ameriben | $103 - $120 | 1495% |
| Asr Health Benefits | $103 - $120 | 1495% |
| Christian Brother Services | $103 - $120 | 1495% |
| Geha | $103 - $122 | 1495% |
| Healthez | $103 - $120 | 1495% |
| Luminare Health (Detroit) | $103 - $120 | 1495% |
| Rural Carrier Health Benefit Plan | $103 - $120 | 1495% |
| First Health | $104 - $121 | 1509% |
| Medi Share | $104 - $121 | 1509% |
| Providence | $104 - $121 | 1509% |