Blood test, lipase
Facility: Phillips County Hospital
Billing Code: 83690 (CPT)
- CPT Billing Code: 83690
- Insurance Median: $41
- Cash Discount Price: $38
- vs. Medicare Baseline: 5.95x 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 595% of the Medicare baseline (a markup of 495%). 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 | $28 - $38 | 406% |
| UnitedHealthcare | $33 - $47 | 479% |
| Health Partners-All Plans | $41 - $47 | 595% |
| Medicaid / KanCare | $41 - $47 | 595% |
Consumer Guidance & Cost Commentary
For the CPT code 83690 (Blood test, lipase) at Phillips County Hospital in Phillipsburg, KS, the facility's cash median price of $38.00 is lower than the state average of $39.00 and the negotiated rate of $41.00. While the hospital is a Critical Access Hospital owned by the local government, patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds this amount. It is important to note that commercial rates often include administrative overhead, which can inflate the baseline price by 20% to 40% compared to the true cost of care represented by Medicare benchmarks.
The Medicare amount for this service is $6.89, which serves as the objective baseline for evaluating pricing markups; commercial rates are frequently 200% to 300% of this figure, whereas fair pricing is typically defined as 120% to 150%. To minimize costs, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass costly insurance billing cycles and administrative labor. Additionally, if a balance bill arises from an out-of-network provider or ancillary service, patients should dispute the charge with their insurer rather than paying immediately, as the No Surprises Act protects against unexpected billing for emergency and non-emergency services at in-network facilities.