Blood test, lipase
Facility: Hiawatha Community Hospital
Billing Code: 83690 (CPT)
- CPT Billing Code: 83690
- Insurance Median: $64
- Cash Discount Price: $94
- vs. Medicare Baseline: 9.29x 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 929% of the Medicare baseline (a markup of 829%). 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 - $95 | 377% |
| Humana | $26 - $44 | 377% |
| UnitedHealthcare | $26 - $101 | 377% |
| Blue Cross Blue Shield | $26 - $28 | 377% |
| Ambetter / Centene | $31 - $52 | 450% |
| Centrus Health Direct - All Plans | $52 - $88 | 755% |
| Oscar - All Plans | $52 - $88 | 755% |
| Preferred Hlth - All Plans | $62 - $106 | 900% |
| Wppa Providrs Care - All Plans | $66 - $112 | 958% |
| Cigna | $66 - $112 | 958% |
| Multiplan - All Plans | $67 - $114 | 972% |
| Midlands Choice - All Plans | $67 - $114 | 972% |
| Healthy Blue Mcaid - All Plans | $69 - $118 | 1001% |
Consumer Guidance & Cost Commentary
For the CPT code 83690 (Blood test, lipase) at Hiawatha Community Hospital in Hiawatha, KS, the cash median price is $94.00, which matches the facility's gross charge. This cash rate is significantly lower than the typical negotiated rates paid by insurance plans, which range from $26 to $118 depending on the carrier. For instance, while Aetna and Humana negotiate rates between $26 and $44, carriers like Wppa Providers Care and Multiplan pay up to $114. Because the cash price is often lower than the insurance negotiated rate, patients with high-deductible plans may save money by paying out-of-pocket directly, provided they do not have other coverage that would trigger a higher reimbursement. It is important to verify the specific "self-pay" or "prompt-pay" discount available at the hospital before scheduling, as these upfront payment incentives can further reduce the final amount owed.
The facility's pricing performance is evaluated against federal benchmarks and local averages. The Medicare amount for this service is $6.89, and the facility's cash rate of $94.00 represents a markup of 9.3 times the Medicare rate. While commercial negotiated rates generally average between 200% and 300% of Medicare, the cash price here is notably lower than the median negotiated rate of $64.00 reported for this procedure. Patients should be aware that hospitals often issue summary bills that obscure individual line items; requesting a full itemized audit is the most effective way to identify errors, unbundled codes, or services not rendered, which can occur in over 8