Blood test, creatinine (kidney)
Facility: Decatur Health
Billing Code: 82565 (CPT)
- CPT Billing Code: 82565
- Insurance Median: $16
- Cash Discount Price: $19
- vs. Medicare Baseline: 3.13x 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 313% of the Medicare baseline (a markup of 213%). 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 |
|---|---|---|
| UnitedHealthcare | $13 - $16 | 254% |
| Wppa/Providrs Care- All Plans | $13 | 254% |
| Humana | $13 | 254% |
| Blue Cross Blue Shield | $14 | 273% |
| Midlands Choice- All Plans | $19 | 371% |
| Aetna | $19 - $21 | 371% |
| Medicaid / KanCare | $22 | 430% |
Consumer Guidance & Cost Commentary
For this blood test for creatinine at Decatur Health in Oberlin, Kansas, the facility's cash price of $19.00 is slightly higher than the state average of $15.00 but aligns closely with the county average of $19.00. While commercial insurance plans like UnitedHealthcare and Aetna have negotiated rates ranging from $13 to $21, these amounts often exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans may find it financially beneficial to pay the cash price directly, as the insurance negotiated rates can be higher than the out-of-pocket cost, especially if the patient has not yet met their deductible.
To maximize savings, it is important to verify the specific "self-pay" or "prompt-pay" discount rates offered by the hospital before scheduling, as these upfront payments can significantly reduce the final bill by bypassing costly claims processing. Although the facility is a Critical Access Hospital with a voluntary non-profit ownership, the Medicare benchmark for this service is $5.12, which serves as the objective baseline for evaluating pricing fairness. Commercial rates typically range from 200% to 300% of the Medicare amount, so comparing the facility's cash and negotiated rates directly to the Medicare benchmark provides a clearer picture of the true cost of care than comparing them to the hospital's full chargemaster list.