Blood test, lipase
Facility: Golden Valley Memorial Hospital
Billing Code: 83690 (CPT)
- CPT Billing Code: 83690
- Insurance Median: $7
- Cash Discount Price: $66
- vs. Medicare Baseline: 1.02x 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.
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 | $7 | 102% |
| Home State Health | $7 | 102% |
| Humana | $7 | 102% |
| UnitedHealthcare | $7 - $12 | 102% |
| Ambetter / Centene | $8 | 116% |
Consumer Guidance & Cost Commentary
For this blood test, lipase procedure at Golden Valley Memorial Hospital in Clinton, Missouri, the cash median price is $66, which is significantly lower than the facility's gross charge of $111 and the state average of $70. While the facility's cash rate is below the state average, patients should be aware that commercial insurance plans often negotiate rates that exceed cash prices; for instance, UnitedHealthcare negotiated a rate of $12, and Ambetter / Centene negotiated $8, both higher than the $66 cash rate. This dynamic can make paying out-of-pocket a more cost-effective option for individuals with high-deductible plans who have not yet met their coverage thresholds.
The facility's negotiated rates vary by insurer, with Aetna, Home State Health, Humana, and Ambetter / Centene all settling at $7, while UnitedHealthcare's negotiated rate is $12. These negotiated amounts are notably lower than the facility's gross charge of $111 but higher than the cash price, illustrating how administrative overhead and contract structures can inflate insurance payments. Patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as paying upfront can sometimes reduce the final bill further, though the specific discount amount is not listed in this data. Additionally, since the facility is an in-network provider, the No Surprises Act generally protects patients from balance billing for out-of-network ancillary services, but patients should still request an itemized bill to verify that all charges correspond exactly to the services rendered.