Blood test, creatinine (kidney)
Facility: Clara Barton Hospital
Billing Code: 82565 (CPT)
- CPT Billing Code: 82565
- Insurance Median: $49
- Cash Discount Price: $38
- vs. Medicare Baseline: 9.57x 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 957% of the Medicare baseline (a markup of 857%). 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% |
| 6 Degrees Health - All Plans | $38 | 742% |
| Wppa-All Plans | $43 | 840% |
| UnitedHealthcare | $49 | 957% |
| Aetna | $49 | 957% |
| Phcs - All Plans | $49 | 957% |
| Hlth Partners Of Ks-All Plans | $50 | 977% |
Consumer Guidance & Cost Commentary
For this blood test for creatinine at Clara Barton Hospital in Hoisington, KS, the cash price of $38.00 is lower than the facility's negotiated rate of $49.00 and the median paid amount of $46.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance rates often exceed cash prices due to administrative overhead and contract dynamics. If you have a high-deductible plan or have not yet met your deductible, paying the cash price directly might result in lower out-of-pocket costs compared to using insurance, which could lead to higher allowed amounts or balance billing if the provider is out-of-network for specific services.
To ensure you are receiving fair pricing, it is important to compare rates against objective benchmarks rather than the hospital's gross charges. In this case, the Medicare amount for this service is $5.12, which serves as a scientifically validated baseline for cost; commercial negotiated rates typically average between 200% and 300% of this figure, whereas fair pricing is generally defined as 120% to 150%. Before scheduling, you should verify your specific plan's allowed amount and ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% if paid upfront. Additionally, always request a full itemized bill to review every line item and avoid paying for services that were never rendered or codes that may have been incorrectly bundled.