CMS Price Transparency Data

Blood test, lipase

Facility: St Mary Medical Center

Billing Code: 83690 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 83690
Insurance Median: $12
Cash Discount Price: $72
vs. Medicare Baseline: 1.74x Medicare

The contracted insurance negotiated median rate for a Blood test, lipase at St Mary Medical Center is $12. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $6.89, this hospital’s rate is 1.74x the Medicare baseline. Located in Langhorne-Newtown Rd, Langhorne, PA.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$12

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: $72 (1045%)

Insurance Median: $12 (174%)

Cash: $72 (1045% of Medicare)

Ins. Median: $12 (174% 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.

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
Medicaid / KanCare	$6 - $12	87%
Aetna	$7 - $99	102%
Align Senior Care	$7	102%
Blue Cross Blue Shield	$7 - $95	102%
Cigna	$7 - $37	102%
Medicare (plans)	$7 - $12	102%
Health America Advantra	$8	116%
UnitedHealthcare	$8 - $54	116%
Pace-Trinity Health	$11	160%
Ambetter / Centene	$12	174%
Keystone First	$12	174%
Keystone First Chip	$12	174%
Oscar	$12	174%
Prime Healthcare	$12	174%
Homestead Health Plans Woods Center	$13	189%
Jefferson Health Plan Commercial	$13	189%
Group Pension Administrators	$16	232%
Reedman Toll	$16	232%
Blue Shield - Pa (Highmark)	$19	276%
Amerihealth	$37	537%
Blue Shield - Ca	$37	537%
Blue Shield - Id (Regence)	$37	537%
Blue Shield - Ny Highmark Western	$37	537%
Blue Shield - Wa (Regence)	$37	537%
Upmc Health Plan	$37	537%
Webtpa	$37	537%
Geha	$45	653%
Meritain	$99	1437%
Multiplan	$100	1451%
Prime Health Services	$100	1451%
Galaxy Health Network	$105	1524%
Three Rivers Provider Network	$105	1524%

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 $72.
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 St Mary Medical 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.