CMS Price Transparency Data

Blood test, lipase

Facility: UPMC St Margaret

Billing Code: 83690 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 83690
Insurance Median: $108
Cash Discount Price: $242
vs. Medicare Baseline: 15.67x Medicare

The contracted insurance negotiated median rate for a Blood test, lipase at UPMC St Margaret is $108. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $242. Compared to the federal Medicare reimbursement reference rate of $6.89, this hospital’s rate is 15.67x the Medicare baseline. Located in 815 Freeport Road, Pittsburgh, PA.

Cash / Self-Pay

$242

Average discount available for prompt cash payment at this facility.

Insurance Median

$108

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: $242 (3512%)

Insurance Median: $108 (1567%)

Cash: $242 (3512% of Medicare)

Ins. Median: $108 (1567% 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 1567% of the Medicare baseline (a markup of 1467%). 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
UnitedHealthcare	$6	87%
Upmc Health Plan	$6 - $12	87%
Aetna	$7 - $162	102%
Highmark Wholecare (Prev Gateway)	$7	102%
Pa Health & Wellness	$7 - $9	102%
Upmc Work Partners	$7	102%
Amerihealth Caritas	$8	116%
Blue Cross Blue Shield	$13 - $62	189%
Cigna	$113 - $162	1640%
Coventry/First Health	$283	4107%
Private Health Care Systems	$323	4688%
Selectcare	$323	4688%
Humana	$343	4978%

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 $242.
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 UPMC St Margaret 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.