Blood test, lipase
Facility: Ellsworth County Medical Center
Billing Code: 83690 (CPT)
- CPT Billing Code: 83690
- Insurance Median: $54
- Cash Discount Price: $60
- vs. Medicare Baseline: 7.84x 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 784% of the Medicare baseline (a markup of 684%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $26 - $28 | 377% |
| Humana | $28 - $57 | 406% |
| Va Ccn-All Plans | $28 | 406% |
| Healthy Blue Mcr Adv | $28 | 406% |
| Triwest -All Plans | $28 | 406% |
| UnitedHealthcare | $39 - $60 | 566% |
| First Health - All Plans | $54 | 784% |
| Aetna | $54 | 784% |
| Cigna | $57 | 827% |
| Coventry Mcaid-All Plans | $60 | 871% |
| Healthy Blue Mcaid- All Other Plans | $60 | 871% |
| Medicaid / KanCare | $60 | 871% |
| Providers Care-Wppa-All Plans | $90 | 1306% |
Consumer Guidance & Cost Commentary
For the CPT code 83690 (Blood test, lipase) at Ellsworth County Medical Center in Ellsworth, KS, the facility's cash price of $60.00 aligns exactly with the gross charge and the cash median. This rate is significantly higher than the Medicare benchmark of $6.89, reflecting a markup common in commercial pricing where negotiated rates often average 200% to 300% of the federal baseline. While the facility is a Critical Access Hospital with a proprietary ownership structure, patients should be aware that commercial negotiated rates for this service range widely among payers, from as low as $26 with Blue Cross Blue Shield to $90 with Providers Care-Wppa-All Plans. Because insurance contracts can include administrative overheads that inflate the baseline price by 20% to 40%, a patient with a high-deductible plan might find paying the $60.00 cash price more cost-effective than using an in-network plan where the allowed amount exceeds the cash rate.
To minimize out-of-pocket costs, patients should proactively inquire about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can bypass the costly insurance billing cycle and administrative fees. Although the facility's negotiated median rate is $54.00, which is lower than the gross charge, it remains above the Medicare benchmark, highlighting the importance of comparing rates against the federal cost baseline rather than the hospital's list price. Given that over 80% of hospital bills contain errors, patients are encouraged to request a full itemized CPT-coded bill to verify that no unbundled codes or services not rendered are included.