CMS Price Transparency Data

Blood test, lipase

Facility: Adena Fayette Medical Center

Billing Code: 83690 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 83690
Insurance Median: $21
Cash Discount Price: $16
vs. Medicare Baseline: 3.05x Medicare

The contracted insurance negotiated median rate for a Blood test, lipase at Adena Fayette Medical Center is $21. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16. Compared to the federal Medicare reimbursement reference rate of $6.89, this hospital’s rate is 3.05x the Medicare baseline. Located in 1430 Columbus Avenue, Washington Ch, OH.

Cash / Self-Pay

$16

Average discount available for prompt cash payment at this facility.

Insurance Median

$21

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: $16 (232%)

Insurance Median: $21 (305%)

Cash: $16 (232% of Medicare)

Ins. Median: $21 (305% 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 305% of the Medicare baseline (a markup of 205%). 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
Blue Cross Blue Shield	$3 - $22	44%
Aetna	$13 - $50	189%
Buckeye Community Health Plan	$13	189%
Humana	$13	189%
Medical Mutual Of Ohio	$13 - $25	189%
Medigold	$13	189%
Molina	$13	189%
Care Source	$14	203%
Molina Marketplace	$15	218%
United Medical Resources Ohcp	$21	305%
UnitedHealthcare	$21	305%
Cigna	$23	334%
Ohio Ppo Connect	$23	334%
The Health Plan	$23	334%
Care Source Just4Me	$24	348%
Medical Mutual Of Ohio Supermed	$25	363%
First Health	$26 - $50	377%
Ohio Health Choice	$26	377%
Multiplan/Private Healthcare Systems	$31	450%
Sidecar Health	$37	537%

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 $16.
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 Adena Fayette Medical Center 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.