CMS Price Transparency Data

Blood test, lipase

Facility: Hamilton Memorial Hospital

Billing Code: 83690 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 83690
Insurance Median: $40
Cash Discount Price: $43
vs. Medicare Baseline: 5.81x Medicare

The contracted insurance negotiated median rate for a Blood test, lipase at Hamilton Memorial Hospital is $40. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $43. Compared to the federal Medicare reimbursement reference rate of $6.89, this hospital’s rate is 5.81x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$43

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: $43 (624%)

Insurance Median: $40 (581%)

Cash: $43 (624% 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
Blue Cross Blue Shield	$19 - $46	276%
Medicaid / KanCare	$19 - $20	276%
Aetna	$20 - $45	290%
Health Alliance	$20 - $40	290%
Humana	$20	290%
Medicare (plans)	$20	290%
UnitedHealthcare	$20 - $36	290%
Wellcare	$20	290%
Alliance Coal	$35	508%
Healthscope	$35	508%
Wellfirst (Ssmhic)	$35	508%
Hope Trust	$38	552%
Cigna	$40	581%
Hfn, Inc	$40 - $45	581%
Healthlink	$43 - $45	624%
Multiplan	$43	624%
Siho	$45	653%
Three Rivers Provider	$45	653%
Healthsmart	$48	697%
Stratose	$48	697%

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 $43.
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 Hamilton 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.