CMS Price Transparency Data

Blood test, creatinine (kidney)

Facility: Stoughton Hospital

Billing Code: 82565 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 82565
Insurance Median: $29
Cash Discount Price: $46
vs. Medicare Baseline: 5.66x Medicare

The contracted insurance negotiated median rate for a Blood test, creatinine (kidney) at Stoughton Hospital is $29. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $46. Compared to the federal Medicare reimbursement reference rate of $5.12, this hospital’s rate is 5.66x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$46

Average discount available for prompt cash payment at this facility.

Insurance Median

$29

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: $46 (898%)

Insurance Median: $29 (566%)

Cash: $46 (898% of Medicare)

Ins. Median: $29 (566% 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 566% of the Medicare baseline (a markup of 466%). 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
Alliance - All Plans	$4	78%
Medicaid / KanCare	$5	98%
Tricare	$20	391%
Healthnet Mcr Adv - All Plans	$22	430%
Dean Health Insurance Med Adv	$24	469%
Humana	$24 - $76	469%
Quartz Mcr Adv	$24	469%
Security Health/First Health - All Plans	$24	469%
Aetna	$25 - $71	488%
Dean Health Insurance Comm - All Other Plans	$29	566%
Dean Health Insurance Epo	$29	566%
UnitedHealthcare	$37 - $67	723%
Geha - All Plans	$63	1230%
Cigna	$67	1309%
Wisconsin Ppo Ppa Direct - All Plans	$67	1309%
Blue Cross Blue Shield	$73	1426%
Wps - All Plans	$76	1484%
Quartz Health Solutions - All Other Lans	$109	2129%

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 $46.
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 Stoughton 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.