CMS Price Transparency Data

Blood test, lipase

Facility: Sanford Clear Lake Medical Center

Billing Code: 83690 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 83690
Insurance Median: $98
Cash Discount Price: $95
vs. Medicare Baseline: 14.22x Medicare

The contracted insurance negotiated median rate for a Blood test, lipase at Sanford Clear Lake Medical Center is $98. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $95. Compared to the federal Medicare reimbursement reference rate of $6.89, this hospital’s rate is 14.22x the Medicare baseline. Located in 701 Third Avenue South, Clear Lake, SD.

Cash / Self-Pay

$95

Average discount available for prompt cash payment at this facility.

Insurance Median

$98

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: $95 (1379%)

Insurance Median: $98 (1422%)

Cash: $95 (1379% of Medicare)

Ins. Median: $98 (1422% 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 1422% of the Medicare baseline (a markup of 1322%). 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
Sanford Health Plan Align	$61	885%
Security Health Plan	$65	943%
Aetna	$66 - $103	958%
Health Partners	$66 - $89	958%
Medicare (plans)	$66	958%
Ucare	$66 - $105	958%
UnitedHealthcare	$66 - $99	958%
Wellmark Sd	$66	958%
Primewest	$67	972%
Sanford Health Plan	$82 - $111	1190%
Blue Cross Blue Shield	$97 - $110	1408%
Medica	$98 - $105	1422%
Wellmark	$102 - $104	1480%
Cigna	$107	1553%
First Choice Health Network	$107	1553%
Healthez	$107	1553%
Multiplan	$107	1553%

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 $95.
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 Sanford Clear Lake 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.