CMS Price Transparency Data

Blood test, creatinine (kidney)

Facility: UMass Memorial Health - Harrington Hospital

Billing Code: 82565 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 82565
Insurance Median: $24
Cash Discount Price: $62
vs. Medicare Baseline: 4.69x Medicare

The contracted insurance negotiated median rate for a Blood test, creatinine (kidney) at UMass Memorial Health - Harrington Hospital is $24. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $62. Compared to the federal Medicare reimbursement reference rate of $5.12, this hospital’s rate is 4.69x the Medicare baseline. Located in 100 South Street, Southbridge, MA.

Cash / Self-Pay

$62

Average discount available for prompt cash payment at this facility.

Insurance Median

$24

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$5.12

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $5.12 (100%)

Cash / Self-Pay: $62 (1211%)

Insurance Median: $24 (469%)

Cash: $62 (1211% of Medicare)

Ins. Median: $24 (469% of 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 469% of the Medicare baseline (a markup of 369%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$5 - $85	98%
Blue Cross Blue Shield	$5 - $12	98%
Cigna	$5 - $60	98%
Commonwealth Care Alliance [10103]	$5	98%
Fallon Mcr Supp [20202]	$5	98%
Fallon Mcr [10105]	$5	98%
Institution [10406]	$5	98%
Medicaid / KanCare	$5 - $6	98%
Mgb Mcr [10124]	$5	98%
Senior Whole Health [10110]	$5	98%
Tufts Mcr [10112]	$5	98%
Tufts Us Family [11203]	$5	98%
UnitedHealthcare	$5 - $85	98%
Champva [11001]	$6	117%
Masshealth [20302]	$6	117%
Workers Compensation [20501]	$7	137%
Tufts Connectorcare [10507]	$9	176%
Wellpoint [11112]	$13	254%
Harvard Pilgrim [10701]	$19 - $23	371%
Hne [11108]	$25 - $55	488%
Tufts [11201]	$28 - $60	547%
First Health Network [11120]	$29 - $64	566%
Evernorth Behavioral Health [27]	$31 - $68	605%
Connecticare [11105]	$39 - $85	762%
Fallon Carelon Hlth [28]	$39 - $85	762%
Fallon Mcaid Carelon Hlth [29]	$39 - $85	762%
Grants [20507]	$39 - $85	762%
Masshealth Mcd Mbhp [38]	$39 - $85	762%
Wellsense Mcaid Carelon Hlth [21]	$39 - $85	762%
Fallon Connectorcare [10503]	$45	879%
Hsno/Free Care [10801]	$681	13301%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $62.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 82565.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UMass Memorial Health - Harrington Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 82565.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.