Blood test, lipase
Facility: Decatur Health
Billing Code: 83690 (CPT)
- CPT Billing Code: 83690
- Insurance Median: $39
- Cash Discount Price: $46
- vs. Medicare Baseline: 5.66x 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 566% of the Medicare baseline (a markup of 466%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $31 | 450% |
| UnitedHealthcare | $31 - $39 | 450% |
| Humana | $32 | 464% |
| Blue Cross Blue Shield | $36 | 522% |
| Midlands Choice- All Plans | $46 | 668% |
| Aetna | $46 - $52 | 668% |
| Medicaid / KanCare | $52 | 755% |
Consumer Guidance & Cost Commentary
For this blood test procedure at Decatur Health in Oberlin, KS, the cash median price is $46.00, which is lower than the facility's negotiated rate of $39.00 and the state average of $52.00. While commercial payers like UnitedHealthcare and Aetna have negotiated rates ranging from $31 to $52, patients with high-deductible plans might find paying the cash price directly more cost-effective if their insurance allowed amount exceeds $46.00. It is important to note that the facility's cash rate is also below the Medicare benchmark of $6.89 adjusted for local costs, suggesting the commercial negotiated rates may be inflated by administrative overhead rather than reflecting the true cost of care.
Before scheduling, patients should verify their specific plan's deductible status and request a "self-pay" or "prompt-pay" discount, which can reduce the bill by 20% to 50% if paid upfront. 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 draws, are covered under the facility's network agreements. If you receive an itemized bill, review it carefully to ensure no unbundled codes or charges for services not rendered are included, as over 80% of hospital bills contain errors that can be corrected through a formal written audit dispute.