Blood test, vitamin B12
Facility: Holton Community Hospital
Billing Code: 82607 (CPT)
- CPT Billing Code: 82607
- Insurance Median: $73
- Cash Discount Price: $80
- vs. Medicare Baseline: 4.84x 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 484% of the Medicare baseline (a markup of 384%). 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 |
|---|---|---|
| Aetna | $42 - $134 | 279% |
| UnitedHealthcare | $42 - $134 | 279% |
| Humana | $43 - $72 | 285% |
| Kansas Superior Select - All Plans | $43 - $73 | 285% |
| Blue Cross Blue Shield | $57 | 378% |
| Preferred Health Freedom | $66 - $111 | 438% |
| Preferred Health Fn Select - All Other Plans | $66 - $111 | 438% |
| Preferred Health Professionals | $66 - $111 | 438% |
| Wppa Providers - All Plans | $76 - $128 | 504% |
| Medicaid / KanCare | $80 - $134 | 531% |
Consumer Guidance & Cost Commentary
For the CPT code 82607, representing a blood test for vitamin B12, Holton Community Hospital in Holton, KS, lists a gross charge of $107.00. While the facility's cash median price is $80.00, which is lower than the gross charge, the negotiated rates paid by insurance payers range from $42.00 to $134.00. Notably, the lowest negotiated rate of $42.00 is significantly lower than the facility's cash price, suggesting that for patients with high-deductible plans, using insurance may result in lower out-of-pocket costs compared to paying cash. However, patients should verify their specific plan's deductible status and allowed amount before scheduling, as some commercial rates can exceed cash prices due to administrative overheads included in the contract.
The facility's Medicare benchmarking data indicates a Medicare amount of $15.08, which serves as a baseline for evaluating pricing fairness. Commercial negotiated rates often average between 200% and 300% of Medicare rates, though fair pricing is typically defined as 120% to 150% of this baseline. For this specific service, the median negotiated rate of $73.00 and the cash median of $80.00 should be compared against the facility's specific contract terms rather than the hospital's full chargemaster list. Patients are encouraged to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid in full upfront, bypassing the administrative costs associated with insurance claims processing.