CMS Price Transparency Data

Blood test, creatinine (kidney)

Facility: St Nicholas Hospital

Billing Code: 82565 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 82565
  • Insurance Median: $18
  • Cash Discount Price: $32
  • vs. Medicare Baseline: 3.52x Medicare
The contracted insurance negotiated median rate for a Blood test, creatinine (kidney) at St Nicholas Hospital is $18. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32. Compared to the federal Medicare reimbursement reference rate of $5.12, this hospital’s rate is 3.52x the Medicare baseline. Located in 3100 Superior Ave, Sheboygan, WI.
Cash / Self-Pay
$32

Average discount available for prompt cash payment at this facility.

Insurance Median
$18

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: $32 (625%)
Insurance Median: $18 (352%)
Cash: $32 (625% of Medicare)
Ins. Median: $18 (352% 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 352% of the Medicare baseline (a markup of 252%). 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.

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 - $48 98%
Blue Cross Blue Shield $5 - $18 98%
Community Care Family Care $5 98%
Humana $5 - $41 98%
Managed Health Services $5 98%
Medica $5 98%
Medicaid / KanCare $5 98%
Medicare (plans) $5 98%
Meridian Health Plan $5 98%
Molina Healthcare $5 - $6 98%
Security Health Plan $5 - $31 98%
UnitedHealthcare $5 - $6 98%
P360 Small Group $6 117%
Prevea Health Network $6 117%
Triology $6 - $38 117%
Naphcare $12 234%
Molina Healthcare Of Wi $24 469%
Hshs Employees $26 508%
Arise Health Plan $29 566%
Wea Provider Network $30 - $35 586%
Cigna $34 664%
Interplan $34 664%
Network Health Plan $34 664%
Health Care Alliance $35 684%
Health Eos $36 703%
Healthsmart $36 703%
Wisconsin Physician Service $38 742%
Multiplan/Phcs $40 781%
Choicecare $41 801%
North Central Healthcare Alliance $44 859%
First Health $46 898%
Caterpillar, Inc. $48 938%
Cofinity $48 938%
Live360 $48 938%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3100 Superior Ave, Sheboygan, WI 53081
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals