Blood test, vitamin B12
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 82607 (CPT)
- CPT Billing Code: 82607
- Insurance Median: $34
- Cash Discount Price: $122
- vs. Medicare Baseline: 2.25x 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 $15.08 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 225% of the Medicare baseline (a markup of 125%). 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 |
|---|---|---|
| United Medical Resources Contracted [320454] | $12 - $41 | 80% |
| UnitedHealthcare | $12 - $174 | 80% |
| Aetna | $13 - $15 | 86% |
| Humana | $13 - $15 | 86% |
| Medicaid / KanCare | $13 - $22 | 86% |
| First Health Contracted [320128] | $13 | 86% |
| Medica Contracted [320239] | $14 | 93% |
| Blue Cross Blue Shield | $14 - $41 | 93% |
| Kindful Hospice Contracted [320434] | $15 | 99% |
| Qual Choice Contracted [320325] | $15 | 99% |
| Medicare (plans) | $15 | 99% |
| Halo Hcr Inc Hospice Contracted [320432] | $15 | 99% |
| Cross Timbers Hospice [20098] | $15 | 99% |
| Mercy Mgd Behavioral Health Contracted [320259] | $15 | 99% |
| Pace Of The Ozarks Contracted [320518] | $15 | 99% |
| Globalhealth Contracted [320145] | $15 | 99% |
| Cherokee Nation Health Serv Contracted [320066] | $15 | 99% |
| Tricare | $15 | 99% |
| Medical Associates Health Contracted [320444] | $15 | 99% |
| Kindful Hospice [20434] | $15 | 99% |
| Mercy Hospice Okc [20252] | $15 | 99% |
| Elara Caring Aspire Hospice [20433] | $15 | 99% |
| Halo Hcr Inc Hospice [20432] | $15 | 99% |
| Cigna | $15 - $87 | 99% |
| Dept Of Veteran Affairs Contracted [320106] | $15 | 99% |
| Provider Partners Health Plans Contracted [320450] | $16 | 106% |
| Centivo Contracted [320505] | $25 | 166% |
| Providrs Care Network Contracted [320484] | $29 | 192% |
| Health Systems Inc Contracted [320174] | $41 | 272% |
| Healthscope Contracted [320182] | $41 - $141 | 272% |
| Benefit Management Contracted [320052] | $41 | 272% |
| Insurance System Inc Contracted [320465] | $41 | 272% |
| Point C Contracted [320238] | $41 - $141 | 272% |
| Mercy Benefit Admin Contracted [320251] | $93 - $132 | 617% |
| Show-Me Health Administrators Contracted [320483] | $93 | 617% |
| Imagine 360 Contracted [320494] | $132 | 875% |
| Edison Health Solutions Contracted [320502] | $132 | 875% |
| Ebms Contracted [320493] | $132 | 875% |
| Auxiant Contracted [320462] | $132 - $141 | 875% |
| American Healthcare Alliance Contracted [320020] | $132 | 875% |
| Reflect Health Contracted [320492] | $132 | 875% |
| Yuzu Health Contracted [320521] | $132 | 875% |
| Aither Health Contracted [320449] | $132 | 875% |
| Preferred Health Plan Contracted [320522] | $141 | 935% |
| Healthlink Contracted [320179] | $141 | 935% |
| Federal Medical Center Contracted [320127] | $141 | 935% |
| Compcare Of The Ozarks Contracted [320437] | $149 | 988% |
| Workers Comp [20426] | $150 | 995% |
| Private Health Care Systems Contracted [320320] | $174 | 1154% |
| Multiplan [20270] | $179 | 1187% |
| Multiplan Contracted [320270] | $179 | 1187% |
Consumer Guidance & Cost Commentary
For the CPT code 82607, representing a blood test for vitamin B12, the facility's cash median price is $122.00, which is lower than the gross charge of $188.00. While the facility's negotiated rates with various payers range from $12 to $174, patients with high-deductible plans may find that paying the cash price directly is more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. To secure the lowest possible price, patients should contact the hospital before scheduling to request a "self-pay" or "prompt-pay" discount, which can reduce the bill by 20% to 50% if paid in full upfront. It is important to note that the facility's cash rate does not appear to be significantly higher than the state average, but individual negotiated rates vary widely depending on the specific insurance carrier.
The Medicare benchmark for this service is $15.08, which serves as a baseline for evaluating the facility's pricing structure. The facility's cash price of $122.00 is approximately 2.3 times the Medicare amount, reflecting the typical markup found in commercial billing. While the facility is a voluntary non-profit acute care hospital located in Galena, KS, patients should be aware that balance billing could occur if services are rendered out-of-network, though the No Surprises Act protects against surprise bills for emergency care and non-emergency services at in-network facilities. Consumers are advised to request an itemized bill to verify all charges and avoid paying for services that were not rendered or codes that were unbundled, ensuring they only pay for the actual care