Blood test, lipase
Facility: Northeast Regional Medical Center
Billing Code: 83690 (CPT)
- CPT Billing Code: 83690
- Insurance Median: $173
- Cash Discount Price: $192
- vs. Medicare Baseline: 25.11x 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 2511% of the Medicare baseline (a markup of 2411%). 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 |
|---|---|---|
| Tricare | $6 | 87% |
| Node Champva | $6 | 87% |
| Medicaid / KanCare | $6 - $10 | 87% |
| Blue Pathway/Pathway X | $7 | 102% |
| Medicare (plans) | $7 | 102% |
| Veterans Eval Services | $7 | 102% |
| Blue Prefrerred | $7 | 102% |
| Node Devoted Health McR Adv | $7 | 102% |
| Node Hospice Non Par Agree | $7 | 102% |
| Blue Cross Blue Shield | $7 - $148 | 102% |
| Blue Access | $7 | 102% |
| Node VA | $7 | 102% |
| UnitedHealthcare | $7 - $365 | 102% |
| Us Department of Labor | $9 | 131% |
| Centurion Correctional | $9 | 131% |
| Home State Exchange | $12 | 174% |
| Naphcare | $13 | 189% |
| Immergrun | $14 | 203% |
| Self Pay | $117 - $268 | 1698% |
| Cigna | $165 - $190 | 2395% |
| Aetna | $181 - $406 | 2627% |
| Access Health Services, LLC | $316 | 4586% |
| Multiplan | $365 - $389 | 5298% |
| Healthlink | $365 - $389 | 5298% |
| Coventry Wc | $389 | 5646% |
Consumer Guidance & Cost Commentary
For patients paying out-of-pocket, the most important factor to know immediately is that the cash price for this blood test, lipase procedure is $192. This cash rate is significantly lower than the facility's gross charge of $486, offering a substantial discount for those who can pay in full upfront. Because insurance claims often include administrative overhead and negotiation markups, the cash price can be the most affordable option for individuals with high-deductible plans or those without coverage. Patients should explicitly request self-pay or prompt-pay discounts before scheduling their appointment to ensure they receive the best possible rate, as waiting until after receiving a bill may result in losing these savings.
When comparing this facility's rates to broader market data, the cash price of $192 is notably lower than the median negotiated rate of $173, which represents the average amount insurance companies pay for this service. The facility's gross charge of $486 is substantially higher than the Medicare benchmark of $6.89, highlighting the significant markup often found in commercial billing. While the facility is a Proprietary Acute Care Hospital in Kirksville, MO, with a rating of 2 out of 5, the key takeaway for consumers is that paying directly can bypass the complex billing cycle that inflates costs for insured patients. Always verify your specific plan's allowed amount with the hospital to determine if the cash price truly offers the lowest financial burden for your situation.