CMS Price Transparency Data

Blood test, lipase

Facility: Lexington Memorial Hospital Inc

Billing Code: 83690 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 83690
Insurance Median: $55
Cash Discount Price: $63
vs. Medicare Baseline: 7.98x Medicare

The contracted insurance negotiated median rate for a Blood test, lipase at Lexington Memorial Hospital Inc is $55. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63. Compared to the federal Medicare reimbursement reference rate of $6.89, this hospital’s rate is 7.98x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$63

Average discount available for prompt cash payment at this facility.

Insurance Median

$55

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$6.89

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $6.89 (100%)

Cash / Self-Pay: $63 (914%)

Insurance Median: $55 (798%)

Cash: $63 (914% of Medicare)

Ins. Median: $55 (798% of 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 798% of the Medicare baseline (a markup of 698%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Alliance	$13	189%
Amerihealth	$13 - $19	189%
Carolina Complete	$13	189%
Healthy Blue	$13	189%
Partners	$13	189%
Trillium	$13	189%
UnitedHealthcare	$13 - $56	189%
Vaya	$13	189%
Wellcare	$13	189%
Blue Cross Blue Shield	$18 - $29	261%
Ambetter / Centene	$19	276%
Medcost	$27 - $84	392%
Aetna	$36 - $116	522%
Oscar	$40 - $55	581%
Cigna	$54 - $55	784%
Directnet	$74	1074%
Healthgram Lexington Home Brands	$90	1306%
Healthgram	$100	1451%
Private Healthcare Systems	$102	1480%
Beechstreet	$110	1597%
Humana	$110	1597%
Multiplan	$112	1626%
National Provider Network	$112	1626%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $63.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 83690.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Lexington Memorial Hospital Inc is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 83690.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.