Blood test, creatinine (kidney)
Facility: Regional Medical Center
Billing Code: 82565 (CPT)
- CPT Billing Code: 82565
- Insurance Median: $870
- Cash Discount Price: $34
- vs. Medicare Baseline: 169.92x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 16992% of the Medicare baseline (a markup of 16892%). 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 16992% |
Consumer Guidance & Cost Commentary
For patients paying cash directly, the most important fact to know is that the cash median rate for this blood test is $34, which is significantly lower than the facility's gross charge of $42. While the facility is a Critical Access Hospital in Manchester, Iowa, with a government-local ownership structure, self-pay patients should explicitly ask about "self-pay" or "prompt-pay" discounts at the time of registration to ensure they are receiving the lowest possible cash price. Given that the cash rate is already below the gross charge, patients with high-deductible plans may find this direct payment option more financially advantageous than using insurance, provided the negotiated rate exceeds the cash price.
The broader pricing context reveals that the facility's cash rate of $34 is notably lower than the median negotiated rate of $870 charged by Medical Associates Health Plan - Tri, which is the only payer in this dataset. This substantial difference highlights that commercial insurance contracts often result in much higher costs for patients who do not meet their deductibles. It is also worth noting that while the facility's Medicare amount is $5.12, the data does not provide a state or county average for comparison, so the primary focus for consumers should remain on the stark contrast between the $34 cash rate and the $870 insurance negotiated rate.