Blood test, creatinine (kidney)
Facility: Girard Medical Center
Billing Code: 82565 (CPT)
- CPT Billing Code: 82565
- Insurance Median: $30
- Cash Discount Price: $51
- vs. Medicare Baseline: 5.86x 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 586% of the Medicare baseline (a markup of 486%). 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 - $30 | 215% |
| Aetna | $30 - $149 | 586% |
| Medicare (plans) | $30 | 586% |
| Ambetter / Centene | $30 | 586% |
| Humana | $30 | 586% |
| UnitedHealthcare | $30 - $81 | 586% |
| Kansas Superior Select-All Plans | $30 | 586% |
| Multiplan-All Plans | $79 | 1543% |
| Uhhis-All Plans | $81 | 1582% |
Consumer Guidance & Cost Commentary
For the CPT code 82565, representing a blood test for creatinine (kidney function), the gross charge at Girard Medical Center in Girard, KS, is $85.00. This facility, a Critical Access Hospital owned by a Government Hospital District, has a cash median price of $51.00 and a median negotiated rate of $30.00. While the facility's cash price is lower than its negotiated rates, patients should note that commercial insurance plans often pay significantly higher amounts than the cash price; for instance, UnitedHealthcare plans may pay up to $81.00, whereas the cash option is $51.00. This dynamic suggests that for patients with high-deductible plans or those without insurance, paying the cash median of $51.00 directly could result in substantial savings compared to the negotiated rates their insurers might process.
To ensure you are receiving the most accurate pricing, it is important to request an itemized billing audit before finalizing payment, as summary bills often obscure individual code costs. Additionally, you should inquire about prompt-pay discounts, which can reduce the cash price by 20% to 50% if paid upfront, bypassing the administrative costs associated with insurance claims. While specific county or state average data was not provided in the source material, the facility's Medicare benchmark of $5.12 serves as a federal cost baseline, indicating that the commercial negotiated rates reflect standard market pricing rather than arbitrary markups. Always verify your specific plan's allowed amount with the hospital prior to scheduling to avoid unexpected balance billing or confusion regarding your deductible status.