Blood test, lipase
Facility: Holton Community Hospital
Billing Code: 83690 (CPT)
- CPT Billing Code: 83690
- Insurance Median: $42
- Cash Discount Price: $38
- vs. Medicare Baseline: 6.10x 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 610% of the Medicare baseline (a markup of 510%). 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 | $26 - $50 | 377% |
| UnitedHealthcare | $26 - $50 | 377% |
| Kansas Superior Select - All Plans | $27 | 392% |
| Humana | $27 | 392% |
| Blue Cross Blue Shield | $28 | 406% |
| Preferred Health Fn Select - All Other Plans | $42 | 610% |
| Preferred Health Freedom | $42 | 610% |
| Preferred Health Professionals | $42 | 610% |
| Wppa Providers - All Plans | $48 | 697% |
| Medicaid / KanCare | $50 | 726% |
Consumer Guidance & Cost Commentary
For the blood test, lipase procedure (CPT 83690) at Holton Community Hospital in Holton, Kansas, the facility's cash median price is $38.00, which is lower than the state average of $42.00. While the hospital's negotiated rates with major payers like Aetna and UnitedHealthcare range from $26 to $50, patients with high-deductible plans may find paying the cash price directly more cost-effective if their insurance allows exceed the cash rate. It is important to note that while the facility is a Critical Access Hospital, patients should verify their specific plan's deductible status before relying on insurance, as some in-network contracts can result in higher out-of-pocket costs than self-pay options.
To ensure you receive the most accurate billing, always request an itemized bill that breaks down every specific code and charge, as summary bills often hide errors or unbundled services. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to confirm that all ancillary services, such as lab work, are covered under your plan's network agreements. Additionally, if you choose to pay out-of-pocket, ask the billing department about prompt-pay discounts, which can further reduce the total amount owed by offering immediate payment incentives.