CMS Price Transparency Data

Blood test, creatinine (kidney)

Facility: UPMC Northwest

Billing Code: 82565 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 82565
Insurance Median: $24
Cash Discount Price: $35
vs. Medicare Baseline: 4.69x Medicare

The contracted insurance negotiated median rate for a Blood test, creatinine (kidney) at UPMC Northwest is $24. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $35. Compared to the federal Medicare reimbursement reference rate of $5.12, this hospital’s rate is 4.69x the Medicare baseline. Located in 100 Fairfield Drive, Seneca, PA.

Cash / Self-Pay

$35

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: $35 (684%)

Insurance Median: $24 (469%)

Cash: $35 (684% 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 - $38	98%
Blue Cross Blue Shield	$5 - $32	98%
Geisinger	$5	98%
UnitedHealthcare	$5 - $7	98%
Upmc Health Plan	$5 - $7	98%
Upmc Work Partners	$5	98%
Amerihealth Caritas	$6 - $10	117%
Highmark Wholecare (Prev Gateway)	$6 - $10	117%
Pa Health & Wellness	$6 - $11	117%
Cigna	$23 - $38	449%
Intergroup	$38 - $3,704	742%
Coventry/First Health	$41	801%
Health Coalition Partners	$42	820%
Private Health Care Systems	$46	898%
Humana	$49	957%

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 $35.
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 UPMC Northwest 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.