Blood test, lipase
Facility: Nmc Health
Billing Code: 83690 (CPT)
- CPT Billing Code: 83690
- Insurance Median: $86
- Cash Discount Price: $93
- vs. Medicare Baseline: 12.48x 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 $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 1248% of the Medicare baseline (a markup of 1148%). 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 | $22 | 319% |
| Blue Cross Blue Shield | $28 | 406% |
| Wppa | $73 | 1060% |
| Occunet | $80 | 1161% |
| Medincrease Health Plan | $86 | 1248% |
| Samaritan Ministries International | $86 | 1248% |
| Prime Health Services | $100 | 1451% |
| UnitedHealthcare | $120 | 1742% |
| Cigna | $126 | 1829% |
Consumer Guidance & Cost Commentary
For the blood test, lipase procedure (CPT 83690) at Nmc Health in Newton, Kansas, the facility's cash median price is $93.00, which is lower than the state average of $120.00. While commercial insurance plans like Aetna and Blue Cross Blue Shield negotiate rates as low as $22.00, these figures often represent the maximum allowed amount rather than the actual cost to the patient, especially if your deductible has not yet been met. In cases where your insurance negotiated rate exceeds the cash price, paying out-of-pocket can sometimes result in a lower total cost, provided you secure a prompt-pay discount by paying in full upfront. It is important to verify your specific plan's allowed amount before scheduling, as some in-network contracts may still result in higher out-of-pocket expenses compared to self-pay options.
The facility's negotiated rate of $86.00 sits below the gross chargemaster of $133.00, reflecting the typical administrative markup associated with insurance billing. However, patients should be aware that balance billing can occur if out-of-network ancillary services are rendered, even at an in-network hospital, though the No Surprises Act generally protects against such unexpected bills for emergency and non-emergency care. To ensure you are not overcharged, request a full itemized bill that lists every CPT code and unit cost, as summary bills often obscure individual line items. If you receive a bill that seems inconsistent with the data above, you have the right to dispute it in writing and request an audit to identify any errors, unbundled codes, or services not rendered.