Blood test, creatinine (kidney)
Facility: Smith County Memorial Hospital
Billing Code: 82565 (CPT)
- CPT Billing Code: 82565
- Insurance Median: $19
- Cash Discount Price: $20
- vs. Medicare Baseline: 3.71x 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 371% of the Medicare baseline (a markup of 271%). 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% |
| Medicaid / KanCare | $14 - $20 | 273% |
| Multiplan-All Plans | $18 | 352% |
| Wppa-All Plans | $19 | 371% |
| Midlands Choice-All Plans | $19 | 371% |
| UnitedHealthcare | $19 | 371% |
| Health Partners Of Ks Ppo-All Plans | $19 | 371% |
Consumer Guidance & Cost Commentary
For the blood test for creatinine (kidney) at Smith County Memorial Hospital in Smith Center, KS, the cash price is $20.00, which matches the facility's gross charge. This cash rate is significantly lower than the negotiated rates paid by insurance plans, ranging from $14.00 to $20.00 depending on the payer, and notably higher than the Medicare benchmark of $5.12. While the facility is a Critical Access Hospital owned by the local government, patients with high-deductible plans may find that paying the cash price of $20.00 upfront is more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these programs can further reduce the final bill for those paying out of pocket.
The data indicates that the facility's pricing structure aligns closely with the cash median of $20.00, whereas the median amount paid by insurance is $18.00. When comparing commercial rates to the Medicare benchmark, the facility's cash price represents a markup of 3.9 times the federal rate, highlighting the difference between government-set costs and commercial billing. Because the Medicare amount serves as the most reliable baseline for evaluating true cost, patients should avoid using the hospital's full chargemaster list as a reference point, as it inflates the perceived value of any discount. To ensure accuracy and avoid unexpected charges, consumers should request a detailed, itemized bill that breaks down specific CPT codes, rather than accepting a summary invoice that may obscure individual line items or unbundled charges.