Blood test, lipase
Facility: Hospital District #6 Patterson Health Center
Billing Code: 83690 (CPT)
- CPT Billing Code: 83690
- Insurance Median: $45
- Cash Discount Price: $40
- vs. Medicare Baseline: 6.53x 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 653% of the Medicare baseline (a markup of 553%). 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% |
| UnitedHealthcare | $45 - $50 | 653% |
| Providers Care (Wppa)-All Plans | $88 | 1277% |
Consumer Guidance & Cost Commentary
For the CPT code 83690 (Blood test, lipase), the facility's cash median rate of $40.00 is lower than the state average of $45.00, making it a potentially cost-effective option for patients paying out-of-pocket. While the facility's negotiated rates with major payers like Blue Cross Blue Shield and UnitedHealthcare range from $26 to $50, these amounts often exceed the cash price, which can be advantageous for individuals with high-deductible plans who may not yet have met their coverage thresholds. To maximize savings, patients should explicitly request self-pay or prompt-pay discounts before scheduling, as these upfront payment incentives can significantly reduce the final bill by bypassing administrative claim processing fees.
It is important to note that the facility's gross charge of $50.00 serves as the baseline list price, but commercial insurance contracts typically cap payments at negotiated rates that may still be higher than the cash alternative. Although the Medicare amount of $6.89 provides a benchmark for fair pricing, commercial rates often reflect administrative costs and network tiering dynamics that result in higher out-of-pocket costs for insured members. Consumers should avoid accepting summary bills and instead request a detailed, itemized statement to verify that no unbundled codes or services not rendered are included, ensuring they are only paying for the specific lipase test performed.