CMS Price Transparency Data

Blood test, lipase

Facility: St Nicholas Hospital

Billing Code: 83690 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 83690
  • Insurance Median: $131
  • Cash Discount Price: $132
  • vs. Medicare Baseline: 19.01x Medicare
The contracted insurance negotiated median rate for a Blood test, lipase at St Nicholas Hospital is $131. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $132. Compared to the federal Medicare reimbursement reference rate of $6.89, this hospital’s rate is 19.01x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$132

Average discount available for prompt cash payment at this facility.

Insurance Median
$131

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: $132 (1916%)
Insurance Median: $131 (1901%)
Cash: $132 (1916% of Medicare)
Ins. Median: $131 (1901% 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 1901% of the Medicare baseline (a markup of 1801%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Aetna $7 - $218 102%
Blue Cross Blue Shield $7 - $24 102%
Community Care Family Care $7 102%
Humana $7 - $185 102%
Managed Health Services $7 102%
Medica $7 102%
Medicaid / KanCare $7 102%
Medicare (plans) $7 102%
Meridian Health Plan $7 102%
Molina Healthcare $7 - $8 102%
Security Health Plan $7 - $139 102%
UnitedHealthcare $7 - $8 102%
P360 Small Group $8 116%
Prevea Health Network $8 116%
Triology $8 - $172 116%
Naphcare $16 232%
Molina Healthcare Of Wi $91 - $109 1321%
Hshs Employees $99 - $118 1437%
Arise Health Plan $109 - $131 1582%
Wea Provider Network $113 - $157 1640%
Cigna $127 - $153 1843%
Interplan $127 - $153 1843%
Network Health Plan $127 - $153 1843%
Health Care Alliance $133 - $159 1930%
Health Eos $136 - $164 1974%
Healthsmart $136 - $164 1974%
Wisconsin Physician Service $146 - $174 2119%
Multiplan/Phcs $153 - $183 2221%
Choicecare $155 - $185 2250%
North Central Healthcare Alliance $167 - $201 2424%
First Health $173 - $207 2511%
Caterpillar, Inc. $182 - $218 2642%
Cofinity $182 - $218 2642%
Live360 $182 - $218 2642%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3100 Superior Ave, Sheboygan, WI 53081
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals