CMS Price Transparency Data

Blood test, lipase

Facility: Porter Hospital Inc

Billing Code: 83690 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 83690
Insurance Median: $40
Cash Discount Price: $72
vs. Medicare Baseline: 5.81x Medicare

The contracted insurance negotiated median rate for a Blood test, lipase at Porter Hospital Inc is $40. 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 5.81x the Medicare baseline. Located in 115 Porter Drive, Middlebury, VT.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$40

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: $40 (581%)

Cash: $72 (1045% of Medicare)

Ins. Median: $40 (581% 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 581% of the Medicare baseline (a markup of 481%). 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
Humana	$7	102%
Fidelis Care	$30	435%
Aetna	$34	493%
Capital District Physicians' Health Plan	$34 - $60	493%
Martins Point	$34	493%
Mvp	$34 - $67	493%
UnitedHealthcare	$34 - $71	493%
Veterans Affairs Community Care Network	$34	493%
Veterans Choice	$34	493%
Blue Cross Blue Shield	$35 - $70	508%
Wellpath	$40	581%
Harvard Pilgrim	$58	842%
Coventry	$63	914%
Cigna	$65	943%
Medical Corporation	$68	987%
Multiplan	$68	987%

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 Porter Hospital Inc 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.