CMS Price Transparency Data

Blood test, creatinine (kidney)

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 82565 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 82565
Insurance Median: $53
Cash Discount Price: $67
vs. Medicare Baseline: 10.35x Medicare

The contracted insurance negotiated median rate for a Blood test, creatinine (kidney) at UPMC Children's Hospital of Pittsburgh is $53. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $67. Compared to the federal Medicare reimbursement reference rate of $5.12, this hospital’s rate is 10.35x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$67

Average discount available for prompt cash payment at this facility.

Insurance Median

$53

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: $67 (1309%)

Insurance Median: $53 (1035%)

Cash: $67 (1309% of Medicare)

Ins. Median: $53 (1035% 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 1035% of the Medicare baseline (a markup of 935%). 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 - $62	98%
Blue Cross Blue Shield	$5 - $42	98%
Health Plan Of Upper Ohio Valley	$5 - $73	98%
Amerihealth Caritas	$6 - $24	117%
Cigna	$6 - $62	117%
Upmc Health Plan	$15 - $26	293%
Health Partners Plans (Jefferson Health Plan)	$25	488%
UnitedHealthcare	$25 - $53	488%
Geisinger	$26 - $50	508%
Highmark Wholecare (Prev Gateway)	$26	508%
Pa Health & Wellness	$26	508%
Intergroup	$73 - $95	1426%
Coventry/First Health	$90	1758%
Saudi Armed Forces	$90	1758%
Health Payors Organization	$95	1855%
Multiplan	$95	1855%
National Provider Network	$101	1973%
Private Health Care Systems	$101	1973%

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 $67.
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 Children's Hospital of Pittsburgh 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.