Blood test, creatinine (kidney)
Facility: William Newton Hospital
Billing Code: 82565 (CPT)
- CPT Billing Code: 82565
- Insurance Median: $14
- Cash Discount Price: $38
- vs. Medicare Baseline: 2.73x 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 273% of the Medicare baseline (a markup of 173%). 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 | $2 - $36 | 39% |
| Blue Cross Blue Shield | $10 - $14 | 195% |
| Ambetter / Centene | $13 - $40 | 254% |
| Triwest- All Plans | $13 - $14 | 254% |
| Providrs Care Nexus | $22 - $24 | 430% |
| Providrs Care - All Other Plans | $25 - $28 | 488% |
Consumer Guidance & Cost Commentary
For this blood test for creatinine at William Newton Hospital in Winfield, KS, the cash price is $38.00, which matches the facility's median negotiated rate of $14.00 when compared to the state average. While the facility is a Critical Access Hospital with a government-local ownership structure, patients should be aware that commercial insurance plans often pay significantly less than the cash price due to administrative overhead and contract dynamics. For instance, UnitedHealthcare plans pay an average of $14.00, whereas cash payment remains at $38.00. In cases where a patient has a high deductible or no insurance, paying the cash price directly can sometimes be more cost-effective than relying on an insurance plan that negotiates a lower allowed amount, provided the patient understands their specific plan's coverage limits.
To ensure you are not overcharged, it is crucial to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, patients should inquire about "prompt-pay" discounts, which can reduce the total cost by 20% to 50% if paid in full upfront, bypassing the costly insurance claims cycle. If you receive a balance bill from an out-of-network provider, such as for emergency services or ancillary lab work, you may be protected under the No Surprises Act, which bans balance billing for these specific scenarios. Always verify your plan's network status and deductible requirements before scheduling, and never sign consent waivers that waive your rights to dispute out-of-network charges without fully understanding the terms.