CMS Price Transparency Data

Blood test, lipase

Facility: Stoughton Hospital

Billing Code: 83690 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 83690
Insurance Median: $46
Cash Discount Price: $85
vs. Medicare Baseline: 6.68x Medicare

The contracted insurance negotiated median rate for a Blood test, lipase at Stoughton Hospital is $46. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $85. Compared to the federal Medicare reimbursement reference rate of $6.89, this hospital’s rate is 6.68x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$85

Average discount available for prompt cash payment at this facility.

Insurance Median

$46

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: $85 (1234%)

Insurance Median: $46 (668%)

Cash: $85 (1234% of Medicare)

Ins. Median: $46 (668% 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 668% of the Medicare baseline (a markup of 568%). 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
Medicaid / KanCare	$5	73%
Alliance - All Plans	$11	160%
Tricare	$37	537%
Dean Health Insurance Comm - All Other Plans	$38	552%
Dean Health Insurance Epo	$38	552%
Healthnet Mcr Adv - All Plans	$41	595%
Dean Health Insurance Med Adv	$43	624%
Humana	$43 - $139	624%
Quartz Mcr Adv	$43	624%
Security Health/First Health - All Plans	$43	624%
Aetna	$46 - $131	668%
UnitedHealthcare	$68 - $123	987%
Quartz Health Solutions - All Other Lans	$98	1422%
Geha - All Plans	$116	1684%
Cigna	$123	1785%
Wisconsin Ppo Ppa Direct - All Plans	$123	1785%
Blue Cross Blue Shield	$134	1945%
Wps - All Plans	$139	2017%

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 $85.
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 Stoughton Hospital 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.