Blood test, average blood sugar (A1c)
Facility: Nmc Health
Billing Code: 83036 (CPT)
- CPT Billing Code: 83036
- Insurance Median: $89
- Cash Discount Price: $91
- vs. Medicare Baseline: 9.17x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $9.71 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 917% of the Medicare baseline (a markup of 817%). 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.
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 | $31 - $113 | 319% |
| Blue Cross Blue Shield | $36 | 371% |
| Wppa | $67 - $75 | 690% |
| Occunet | $73 - $82 | 752% |
| Samaritan Ministries International | $79 - $89 | 814% |
| Medincrease Health Plan | $79 - $89 | 814% |
| Prime Health Services | $91 - $103 | 937% |
| UnitedHealthcare | $109 - $123 | 1123% |
| Cigna | $115 - $130 | 1184% |
Consumer Guidance & Cost Commentary
For this blood sugar test (A1c) at Nmc Health in Newton, KS, the cash price of $91 is significantly lower than the facility's negotiated rates for most major insurers, which range from $73 to $130. This pricing structure highlights a common billing dynamic where commercial insurance contracts often exceed cash-pay prices due to administrative overhead and multi-layered contract dynamics. For patients with high-deductible plans, paying the $91 cash rate upfront can be more cost-effective than relying on insurance, which may result in a higher allowed amount that only partially covers the cost after deductibles are met. Additionally, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing the costly insurance claims processing cycle.
When evaluating the cost against broader benchmarks, the facility's cash rate of $91 is notably higher than the state average for this service, though it remains well below the facility's gross chargemaster price of $129. It is important to note that while the facility is an in-network location for many payers, balance billing can still occur if ancillary services like emergency physicians or specific lab components are out-of-network, potentially triggering unexpected charges beyond the negotiated rate. To avoid these surprises, consumers should request a full itemized bill before paying and verify that all services rendered are properly coded and included in the negotiated rate. Disputing any unexpected charges with the insurer or requesting a formal audit can help ensure that the patient only pays the agreed-upon negotiated amount or the cash rate, rather than the inflated full chargemaster price.