Blood test, lipase
Facility: William Newton Hospital
Billing Code: 83690 (CPT)
- CPT Billing Code: 83690
- Insurance Median: $31
- Cash Discount Price: $78
- vs. Medicare Baseline: 4.50x 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 450% of the Medicare baseline (a markup of 350%). 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 |
|---|---|---|
| UnitedHealthcare | $5 - $78 | 73% |
| Triwest- All Plans | $24 - $30 | 348% |
| Ambetter / Centene | $25 - $87 | 363% |
| Blue Cross Blue Shield | $25 - $31 | 363% |
| Providrs Care Nexus | $43 - $53 | 624% |
| Providrs Care - All Other Plans | $49 - $61 | 711% |
Consumer Guidance & Cost Commentary
For the CPT code 83690, representing a blood test for lipase at William Newton Hospital in Winfield, KS, the facility's cash price is $78.00. This cash rate is significantly higher than the Medicare benchmark of $6.89, which serves as the federal baseline for the true cost of this service. While the hospital is a Critical Access Hospital with a government-local ownership structure, patients should note that commercial insurance negotiated rates vary widely; for instance, UnitedHealthcare plans pay up to $78.00, while Triwest-All Plans pay as low as $24.00. Because commercial negotiated rates often include administrative overhead and contract dynamics that inflate the baseline price, it is important to verify your specific plan's allowed amount before scheduling, as some in-network rates may exceed the cash price.
To potentially lower your out-of-pocket costs, you should inquire directly with the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the total bill by 20% to 50% if paid upfront. Additionally, since the facility's cash rate of $78.00 is notably higher than the Medicare amount, patients with high-deductible plans might find paying the cash price more affordable than having insurance cover a negotiated rate that exceeds their deductible threshold. If you receive a bill, always request a full itemized statement to ensure no errors exist, as over 80% of hospital bills contain mistakes such as double-billing or unbundled codes. Finally, be aware that under the No Surprises Act, you are protected from balance billing for out-of-network services at in-network facilities, so do not feel pressured