Blood test, lipase
Facility: Community Memorial Healthcare, Inc.
Billing Code: 83690 (CPT)
- CPT Billing Code: 83690
- Insurance Median: $28
- Cash Discount Price: $47
- vs. Medicare Baseline: 4.06x 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 406% of the Medicare baseline (a markup of 306%). 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 | $21 - $37 | 305% |
| UnitedHealthcare | $26 - $28 | 377% |
| Blue Cross Blue Shield | $28 | 406% |
Consumer Guidance & Cost Commentary
For this blood test for lipase at Community Memorial Healthcare, Inc. in Marysville, Kansas, the cash price is $47.00, which matches the facility's median negotiated rate of $28.00 and the cash median of $47.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the data indicates that the cash price is significantly higher than the state average, which is $6.89 according to the Medicare benchmark provided. Patients with high-deductible plans may find it beneficial to pay the cash price directly, as the negotiated rate of $28.00 often exceeds the cash price, potentially leading to higher out-of-pocket costs if their insurance does not cover the full amount. It is important to verify the specific allowed amount with the hospital before scheduling to ensure you are not paying more than necessary.
When reviewing the billing details, it is crucial to understand that the gross charge of $47.00 represents the full list price, while the actual amount paid by insurance is typically lower due to negotiated contracts. The facility's median paid amount is $39.00, and the Medicare amount for this service is $6.89, highlighting the significant markup often seen in commercial billing. To avoid unexpected costs, patients should request a prompt-pay discount if paying in full upfront, which can reduce the bill by 20% to 50% by bypassing administrative claim processing fees. Additionally, if you receive an itemized bill, ensure it is fully detailed rather than a summary to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected through