Blood test, creatinine (kidney)
Facility: Rooks County Health Center
Billing Code: 82565 (CPT)
- CPT Billing Code: 82565
- Insurance Median: $56
- Cash Discount Price: $47
- vs. Medicare Baseline: 10.94x 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 $5.12 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 1094% of the Medicare baseline (a markup of 994%). 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 |
|---|---|---|
| Veterans Admin - All Plans | $3 | 59% |
| Blue Cross Blue Shield | $11 | 215% |
| Celtic Mcr Adv | $29 - $30 | 566% |
| Tricare | $29 - $30 | 566% |
| Celtic Comm - All Other Plans | $32 - $33 | 625% |
| Preferred Benefits Admin | $56 - $57 | 1094% |
| UnitedHealthcare | $56 - $57 | 1094% |
| Aetna | $56 - $57 | 1094% |
| Health Partners - All Plans | $59 - $61 | 1152% |
| Preferred Hlthcare - All Other Plans | $59 - $61 | 1152% |
| Healthy Blue Mcaid - All Plans | $62 - $64 | 1211% |
Consumer Guidance & Cost Commentary
For the CPT code 82565, representing a blood test for creatinine (kidney function), the facility's cash median rate is $47.00, which is lower than the negotiated rates paid by most insurance plans. While the facility's cash price is notably lower than the state average of $56.00, patients with high-deductible plans may find that paying cash upfront is the most cost-effective option, as many insurers negotiate rates that exceed the cash price. It is important to note that while the facility is a Critical Access Hospital in Plainville, KS, and is owned by a Government Hospital District, the specific negotiated rates vary significantly by payer, ranging from $3.00 for Veterans Admin plans to $64.00 for Healthy Blue Mcaid plans.
To ensure you are not overcharged, we recommend requesting a full itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, if you are self-paying, ask the billing department about "prompt-pay" discounts, which can reduce the total cost by 20% to 50% if settled within a short window. If you have insurance, verify your deductible status before scheduling, as paying the negotiated rate without meeting your deductible could result in higher out-of-pocket costs than paying cash. Finally, if you receive a surprise bill from an out-of-network provider at this in-network facility, you may be protected under the No Surprises Act, which bans balance billing for emergency and non-emergency services.