Blood test, creatinine (kidney)
Facility: Clay County Medical Center
Billing Code: 82565 (CPT)
- CPT Billing Code: 82565
- Insurance Median: $40
- Cash Discount Price: $42
- vs. Medicare Baseline: 7.81x 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 781% of the Medicare baseline (a markup of 681%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $39 | 762% |
| Aetna | $39 | 762% |
| Health Partners - All Plans | $40 | 781% |
| UnitedHealthcare | $40 | 781% |
| Multiplan- All Plans | $40 | 781% |
Consumer Guidance & Cost Commentary
For the blood test for creatinine at Clay County Medical Center in Clay Center, KS, the cash price is $42.00, which matches the facility's median negotiated rate of $40.00 and the cash median. This service is provided by a Critical Access Hospital owned by the local government, and while the facility has a rating of 3, the pricing structure suggests that paying out-of-pocket may be more cost-effective than using insurance. In this case, the cash price is lower than the median allowed amount of $39.00 paid by insurers like Aetna and UnitedHealthcare, meaning patients with high-deductible plans could save money by paying the cash rate directly. It is important to confirm with the hospital whether a "self-pay" or "prompt-pay" discount is available before scheduling, as these upfront incentives can further reduce the final bill.
The Medicare benchmark for this procedure is $5.12, which serves as a baseline for evaluating the facility's pricing markup. The commercial rates observed here are significantly higher than the Medicare amount, reflecting the administrative costs and contract dynamics typical of in-network billing. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, it is still crucial to request an itemized bill to ensure no unbundled codes or services not rendered are included. Since over 80% of hospital bills contain errors, reviewing the line-by-line charges can help identify any discrepancies before payment. Ultimately, comparing the cash price of $42.00 against the Medicare rate of $5.12 highlights the importance of understanding the true cost of care versus the inflated chargemaster lists often used