Blood test, creatinine (kidney)
Facility: Nemaha Valley Community Hospital
Billing Code: 82565 (CPT)
- CPT Billing Code: 82565
- Insurance Median: $15
- Cash Discount Price: $26
- vs. Medicare Baseline: 2.93x 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 293% of the Medicare baseline (a markup of 193%). 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 |
|---|---|---|
| Va Ccn - All Plans | $1 | 20% |
| Aetna | $13 - $25 | 254% |
| Humana | $13 | 254% |
| Celtic Comm Exch - All Plans | $14 | 273% |
| Partners Direct Health - All Plans | $15 | 293% |
| Multiplan - All Plans | $26 | 508% |
| Health Partners - All Plans | $28 | 547% |
| Midlands Choice - All Plans | $28 | 547% |
Consumer Guidance & Cost Commentary
For this blood test for creatinine at Nemaha Valley Community Hospital in Seneca, KS, the facility's cash median rate of $26.00 is notably higher than the state average, which sits at $15.00. While the hospital's negotiated rates for in-network payers also average $15.00, patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds this amount. It is important to note that the facility is a Critical Access Hospital, and while the cash rate is higher than the state median, the negotiated rate aligns with the state average, suggesting that insurance coverage might still result in a lower out-of-pocket cost depending on individual plan deductibles.
To minimize costs, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can significantly reduce the final bill by bypassing administrative claim processing fees. Additionally, since the facility is a Voluntary non-profit, patients should request a full itemized billing audit to ensure no errors exist, as over 80% of hospital bills contain discrepancies that can be corrected. Finally, while the Medicare amount for this service is $5.12, which serves as a baseline for fair pricing, the commercial negotiated rates reflect the administrative costs and contract dynamics of the insurance network, so comparing the final allowed amount to the cash price is the most effective way to determine the best financial option.