Blood test, lipase
Facility: Nemaha Valley Community Hospital
Billing Code: 83690 (CPT)
- CPT Billing Code: 83690
- Insurance Median: $39
- Cash Discount Price: $68
- vs. Medicare Baseline: 5.66x 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 566% of the Medicare baseline (a markup of 466%). 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 |
|---|---|---|
| Va Ccn - All Plans | $5 | 73% |
| Aetna | $33 - $64 | 479% |
| Humana | $33 | 479% |
| Celtic Comm Exch - All Plans | $36 | 522% |
| Partners Direct Health - All Plans | $39 | 566% |
| Multiplan - All Plans | $68 | 987% |
| Health Partners - All Plans | $71 | 1030% |
| Midlands Choice - All Plans | $71 | 1030% |
Consumer Guidance & Cost Commentary
For the blood test, lipase procedure (CPT 83690) at Nemaha Valley Community Hospital in Seneca, KS, the facility's cash median rate is $68.00, which is slightly lower than the state average of $68.00. While the hospital's negotiated rates with major payers like Aetna and Humana range from $33 to $64, these amounts are often higher than the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to note that commercial insurance contracts often include administrative overhead that inflates the baseline price by 20% to 40%, so comparing rates directly to the Medicare benchmark of $6.89 reveals that even the lowest negotiated rates exceed the federal cost basis.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, unexpected ancillary charges can still occur if specific lab services are billed separately. To ensure you receive the most accurate pricing, always request a full itemized CPT-coded bill before paying, as summary bills may obscure individual line items or unbundled charges. Additionally, since the facility offers a cash median rate of $68.00, you should explicitly ask for "self-pay" or "prompt-pay" discounts at registration, which can provide a fee reduction of 20% to 50% by bypassing the costly claims processing cycle associated with insurance billing.