Blood test, creatinine (kidney)
Facility: Holton Community Hospital
Billing Code: 82565 (CPT)
- CPT Billing Code: 82565
- Insurance Median: $38
- Cash Discount Price: $34
- vs. Medicare Baseline: 7.42x 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 742% of the Medicare baseline (a markup of 642%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $11 | 215% |
| UnitedHealthcare | $24 - $46 | 469% |
| Aetna | $24 - $46 | 469% |
| Humana | $24 | 469% |
| Kansas Superior Select - All Plans | $25 | 488% |
| Preferred Health Freedom | $38 | 742% |
| Preferred Health Fn Select - All Other Plans | $38 | 742% |
| Preferred Health Professionals | $38 | 742% |
| Wppa Providers - All Plans | $43 | 840% |
| Medicaid / KanCare | $46 | 898% |
Consumer Guidance & Cost Commentary
For the blood test for creatinine (kidney) at Holton Community Hospital, the cash price of $34.00 is lower than the facility's negotiated rates, which range from $11.00 to $46.00 depending on the insurance plan. While the median negotiated rate across payers is $38.00, patients with high-deductible plans might find the cash price more advantageous if their insurance allows the full negotiated amount, which could exceed the cash rate. It is important to note that the facility's cash price is significantly higher than the Medicare benchmark of $5.12, illustrating the typical markup in commercial pricing. Additionally, the cash price is higher than the state average for this service, suggesting that patients should verify if their specific insurance plan offers a negotiated rate closer to the cash price to minimize out-of-pocket costs.
To ensure you are receiving the most accurate pricing, always request an itemized bill before paying, as summary bills often obscure individual code costs and may include unbundled charges or services not rendered. If you choose to pay out-of-pocket, ask the billing department about prompt-pay discounts, which can reduce the total by 20% to 50% if settled within 30 days, effectively bypassing the administrative costs associated with insurance claims. Furthermore, be aware that while the No Surprises Act protects you from balance billing for emergency care at in-network facilities, it is crucial to confirm your plan's status and deductible requirements before scheduling to avoid unexpected financial responsibility.