Blood test, lipase
Facility: Bob Wilson Memorial Hospital
Billing Code: 83690 (CPT)
- CPT Billing Code: 83690
- Insurance Median: $84
- Cash Discount Price: $41
- vs. Medicare Baseline: 12.19x 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 1219% of the Medicare baseline (a markup of 1119%). 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 |
|---|---|---|
| Centura Employee Plan | $9 | 131% |
| UnitedHealthcare | $33 - $86 | 479% |
| Kansas Health | $33 | 479% |
| Humana | $33 | 479% |
| Aetna | $33 - $82 | 479% |
| Medicare (plans) | $33 | 479% |
| Blue Cross Blue Shield | $37 | 537% |
| Multiplan | $93 - $96 | 1350% |
| Health Partners Of Kansas | $97 | 1408% |
| Wppa | $98 | 1422% |
Consumer Guidance & Cost Commentary
For the CPT code 83690 (Blood test, lipase) at Bob Wilson Memorial Hospital in Ulysses, KS, the facility's cash median price is $41.00, which is significantly lower than the state average of $84.00. While commercial payers like UnitedHealthcare and Aetna have negotiated rates ranging from $33 to $86, these amounts often exceed the cash price, making self-pay a potentially more affordable option for patients with high-deductible plans. Because the hospital is a Critical Access Hospital owned by a voluntary non-profit church, it may offer additional self-pay or prompt-pay discounts; patients should explicitly ask for these rates before scheduling to ensure they are not billed the full negotiated amount.
The Medicare benchmark for this service is $6.89, which serves as a reliable baseline for evaluating pricing fairness, as commercial rates are frequently marked up significantly above this federal cost. Although the facility's gross charge is $103.00, the negotiated rates for in-network plans generally align closer to the state average than the gross list price. Consumers should be aware that balance billing is largely prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, meaning unexpected bills for out-of-network ancillary services are often illegal. If a patient receives an itemized bill that appears inflated, they should request a full line-by-line audit to identify any unbundled codes or services not rendered, rather than accepting a summary invoice as the final charge.