Blood test, average blood sugar (A1c)
Facility: Northeast Regional Medical Center
Billing Code: 83036 (CPT)
- CPT Billing Code: 83036
- Insurance Median: $113
- Cash Discount Price: $125
- vs. Medicare Baseline: 11.64x 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 $9.71 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 1164% of the Medicare baseline (a markup of 1064%). 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 |
|---|---|---|
| Medicaid / KanCare | $9 - $14 | 93% |
| Tricare | $9 | 93% |
| Node Champva | $9 | 93% |
| Veterans Eval Services | $10 | 103% |
| Node VA | $10 | 103% |
| Blue Cross Blue Shield | $10 - $97 | 103% |
| Blue Pathway/Pathway X | $10 | 103% |
| Medicare (plans) | $10 | 103% |
| UnitedHealthcare | $10 - $238 | 103% |
| Node Devoted Health McR Adv | $10 | 103% |
| Node Hospice Non Par Agree | $10 | 103% |
| Blue Access | $10 | 103% |
| Blue Prefrerred | $10 | 103% |
| Centurion Correctional | $12 | 124% |
| Us Department of Labor | $12 | 124% |
| Home State Exchange | $17 | 175% |
| Naphcare | $18 | 185% |
| Immergrun | $19 | 196% |
| Self Pay | $76 - $174 | 783% |
| Cigna | $108 - $124 | 1112% |
| Aetna | $118 - $265 | 1215% |
| Access Health Services, LLC | $206 | 2122% |
| Multiplan | $238 - $254 | 2451% |
| Healthlink | $238 - $254 | 2451% |
| Coventry Wc | $254 | 2616% |
Consumer Guidance & Cost Commentary
A self-pay patient should know that paying directly can sometimes result in a lower cost than using insurance, as commercial negotiated rates often exceed cash prices due to administrative overhead. For this blood sugar test (A1c) at Northeast Regional Medical Center, the cash median rate is $125, which is lower than the facility's gross charge of $317. While the facility lists a median negotiated rate of $113 for insurance plans, patients should verify their specific deductible status and ask about "prompt-pay" discounts before scheduling, as these upfront incentives can further reduce out-of-pocket expenses. It is important to request a self-pay classification at registration to ensure the billing system does not automatically submit a claim to an insurer that might charge a higher allowed amount.
In terms of broader pricing context, the facility's cash rate of $125 is significantly lower than the gross charge, highlighting the potential savings of direct payment. The Medicare benchmark for this service is $9.71, which serves as a federal baseline for the true cost of care; commercial rates are often marked up substantially above this figure. While the data does not provide specific county or state average comparisons for this exact procedure, the facility operates as a proprietary acute care hospital in Kirksville, MO, with a facility rating of 2. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, verifying the exact classification of the service and requesting an itemized bill is crucial to avoiding unexpected charges.