CMS Price Transparency Data

Blood test, lipase

Facility: Children's Hospital of Philadelphia

Billing Code: 83690 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 83690
Insurance Median: $132
Cash Discount Price: $296
vs. Medicare Baseline: 19.16x Medicare

The contracted insurance negotiated median rate for a Blood test, lipase at Children's Hospital of Philadelphia is $132. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $296. Compared to the federal Medicare reimbursement reference rate of $6.89, this hospital’s rate is 19.16x the Medicare baseline. Located in 3401 Civic Center Blvd, Philadelphia, PA.

Cash / Self-Pay

$296

Average discount available for prompt cash payment at this facility.

Insurance Median

$132

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: $296 (4296%)

Insurance Median: $132 (1916%)

Cash: $296 (4296% of Medicare)

Ins. Median: $132 (1916% 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 1916% of the Medicare baseline (a markup of 1816%). 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
Geisinger Medical Assistance	$7	102%
Highmark Wholecare	$8	116%
Horizon Nj Health	$16	232%
Medicaid / KanCare	$46 - $52	668%
UnitedHealthcare	$46 - $173	668%
Health Partners	$52 - $59	755%
Aetna	$66 - $157	958%
Upmc Medical Assistance	$76 - $86	1103%
Keystone First Chip	$86 - $98	1248%
Keystone Health Plan East	$88 - $100	1277%
Blue Cross Blue Shield	$98 - $126	1422%
Geisinger Health Plan Commercial	$122 - $139	1771%
Jefferson Health Plans	$132 - $149	1916%
Cigna	$139 - $157	2017%
Highmark	$139 - $157	2017%
Qualcare	$153 - $173	2221%
First Health Network	$181 - $205	2627%
Devon Health, Intergroup, Multiplan, Valley Preferred/Populytics	$222 - $252	3222%
Private Health Care Systems	$222 - $252	3222%
Choice Care Network	$250 - $283	3628%

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 $296.
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 Children's Hospital of Philadelphia 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.