Blood test, lipase
Facility: Girard Medical Center
Billing Code: 83690 (CPT)
- CPT Billing Code: 83690
- Insurance Median: $42
- Cash Discount Price: $72
- vs. Medicare Baseline: 6.10x 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 610% of the Medicare baseline (a markup of 510%). 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 - $42 | 406% |
| Ambetter / Centene | $42 | 610% |
| Aetna | $42 - $210 | 610% |
| Kansas Superior Select-All Plans | $42 | 610% |
| Humana | $42 | 610% |
| Medicare (plans) | $42 | 610% |
| UnitedHealthcare | $42 - $114 | 610% |
| Multiplan-All Plans | $111 | 1611% |
| Uhhis-All Plans | $114 | 1655% |
Consumer Guidance & Cost Commentary
For the blood test, lipase procedure (CPT 83690) at Girard Medical Center in Girard, KS, the facility's negotiated rates range from $28 to $210 depending on the insurance plan, with a median negotiated amount of $42.00. This facility, a Critical Access Hospital owned by a Government Hospital District, charges a cash price of $72.00, which is notably higher than the median negotiated rate of $42.00. While the facility's cash price is higher than the typical negotiated rate, patients with high-deductible plans or those without insurance may find the cash price more predictable. It is important to note that commercial insurance rates often include administrative overhead and contract markups that can exceed the direct cash cost, so self-pay patients should verify if paying upfront avoids the higher administrative fees embedded in insurance billing.
The facility's pricing is benchmarked against Medicare, which sets a fixed reimbursement rate of $6.89 for this service. The facility's cash price of $72.00 represents a markup of 6.1 times the Medicare rate, which is significantly higher than the typical fair pricing range of 120% to 150% of Medicare. Because the facility is a Critical Access Hospital, it is subject to specific federal payment rules that generally cap its rates, yet the cash price remains well above the Medicare benchmark. Patients should be aware that balance billing is prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but out-of-network ancillary services or specific plan limitations could still result in unexpected charges. To minimize costs, patients are encouraged to request a