Blood test, lipase
Facility: Trego County Lemke Memorial Hospital
Billing Code: 83690 (CPT)
- CPT Billing Code: 83690
- Insurance Median: $37
- Cash Discount Price: $37
- vs. Medicare Baseline: 5.37x 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 537% of the Medicare baseline (a markup of 437%). 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 |
|---|---|---|
| Va Ccn - All Plans | $3 | 44% |
| Humana | $22 | 319% |
| Tricare | $23 | 334% |
| Medicaid / KanCare | $27 - $44 | 392% |
| Aetna | $27 - $40 | 392% |
| UnitedHealthcare | $27 - $44 | 392% |
| Ambetter / Centene | $30 | 435% |
| Blue Cross Blue Shield | $38 | 552% |
| Health Partners - All Plans | $42 | 610% |
| Healthy Blue Mcaid - All Plans | $44 | 639% |
Consumer Guidance & Cost Commentary
For the CPT code 83690, representing a blood test for lipase, Trego County Lemke Memorial Hospital lists a cash median price of $37.00 and a median negotiated rate of $37.00. This cash price is notably lower than the facility's gross charge of $44.00, offering potential savings for patients with high-deductible plans who may find the cash rate more affordable than their insurance negotiated rate. While the facility is a Critical Access Hospital in Wakeeney, KS, with government-local ownership, the specific comparison data for county or state averages is not available in the provided records. However, the facility's cash price aligns with the median negotiated rate across all ten payers listed, including Humana, Tricare, and UnitedHealthcare, suggesting a standardized pricing structure for this service.
Patients should be aware that while the facility offers a cash median of $37.00, the Medicare amount for this procedure is $6.89, indicating a significant markup relative to the federal benchmark. Under Medicare benchmarking principles, fair pricing is typically defined between 120% and 150% of the Medicare rate, whereas commercial negotiated rates often average 200% to 300% of Medicare. For this specific code, the gross charge of $44.00 represents a substantial increase over the Medicare amount. Consumers are advised to request an itemized billing audit before payment to ensure no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors. Additionally, patients should inquire about prompt-pay discounts, which can reduce the final balance by 20