Blood test, average blood sugar (A1c)
Facility: Ellsworth County Medical Center
Billing Code: 83036 (CPT)
- CPT Billing Code: 83036
- Insurance Median: $37
- Cash Discount Price: $55
- vs. Medicare Baseline: 3.81x 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 381% of the Medicare baseline (a markup of 281%). 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 | $13 - $39 | 134% |
| Triwest -All Plans | $13 - $39 | 134% |
| Humana | $13 - $79 | 134% |
| Healthy Blue Mcr Adv | $13 - $39 | 134% |
| UnitedHealthcare | $18 - $84 | 185% |
| Aetna | $24 - $75 | 247% |
| First Health - All Plans | $24 - $75 | 247% |
| Cigna | $26 - $79 | 268% |
| Coventry Mcaid-All Plans | $27 - $84 | 278% |
| Healthy Blue Mcaid- All Other Plans | $27 - $84 | 278% |
| Medicaid / KanCare | $27 - $84 | 278% |
| Blue Cross Blue Shield | $34 - $36 | 350% |
| Providers Care-Wppa-All Plans | $40 - $125 | 412% |
Consumer Guidance & Cost Commentary
For the CPT code 83036, representing an average blood sugar (A1c) test, the cash price at Ellsworth County Medical Center is $55.00, which matches the facility's median cash rate. This cash price is significantly lower than the state and county averages for this service, where commercial insurance negotiated rates typically range from $24.00 to $125.00 depending on the payer. For patients with high-deductible plans, paying the $55.00 cash price upfront may be more cost-effective than relying on insurance, as many commercial payers negotiate rates that exceed the cash price due to administrative overhead and contract structures. Patients should verify their specific plan's deductible status before scheduling and inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed.
The facility's Medicare benchmark rate for this procedure is $9.71, serving as a baseline for evaluating pricing fairness. While commercial negotiated rates vary widely among the 13 payers represented, ranging from a low of $13.00 to a high of $125.00, the cash price remains the most transparent figure for consumers. It is important to note that if a patient receives care from an out-of-network provider or if ancillary services are billed separately, they may face balance billing for the difference between the provider's chargemaster and the insurance allowed amount. To avoid unexpected costs, patients should request a full itemized bill before paying and dispute any errors formally in writing, as over 80% of hospital bills contain inaccuracies such as unbundled codes or services not rendered.