CMS Price Transparency Data

Blood test, lipase

Facility: Decatur Memorial Hospital

Billing Code: 83690 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 83690
Insurance Median: $81
Cash Discount Price: $164
vs. Medicare Baseline: 11.76x Medicare

The contracted insurance negotiated median rate for a Blood test, lipase at Decatur Memorial Hospital is $81. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $164. Compared to the federal Medicare reimbursement reference rate of $6.89, this hospital’s rate is 11.76x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$164

Average discount available for prompt cash payment at this facility.

Insurance Median

$81

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: $164 (2380%)

Insurance Median: $81 (1176%)

Cash: $164 (2380% of Medicare)

Ins. Median: $81 (1176% 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 1176% of the Medicare baseline (a markup of 1076%). 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
Blue Cross Blue Shield	$6 - $164	87%
Medicaid / KanCare	$6	87%
Aetna	$7 - $110	102%
Coventry	$7 - $83	102%
Health Alliance	$7 - $109	102%
Humana	$7 - $107	102%
Medicare (plans)	$7	102%
Tricare	$7	102%
UnitedHealthcare	$7 - $164	102%
Veterans Administration	$7	102%
Wellcare	$7	102%
Caterpillar	$9	131%
Plain Church Medical Group	$9 - $74	131%
Illinois Workers Compensation	$40 - $86	581%
Mennonite Churches	$57	827%
Health Alliance Mh Employee Plan	$75	1089%
Cigna	$76	1103%
Hfn	$81 - $123	1176%
Commercial Workers Compensation	$82	1190%
6 Degrees Health	$98	1422%
Hopetrust	$98	1422%
Hst	$98	1422%
Phcs Savility	$107	1553%
Healthlink	$112	1626%
Phcs Multiplan Ppo	$112	1626%
Corvel	$118	1713%
Consociate	$121	1756%
Liability	$164	2380%

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 $164.
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 Decatur Memorial 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.