Blood test, vitamin B12
Facility: Ellsworth County Medical Center
Billing Code: 82607 (CPT)
- CPT Billing Code: 82607
- Insurance Median: $80
- Cash Discount Price: $106
- vs. Medicare Baseline: 5.31x 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 531% of the Medicare baseline (a markup of 431%). 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 |
|---|---|---|
| Va Ccn-All Plans | $39 - $61 | 259% |
| Triwest -All Plans | $39 - $61 | 259% |
| Humana | $39 - $124 | 259% |
| Healthy Blue Mcr Adv | $39 - $61 | 259% |
| UnitedHealthcare | $53 - $130 | 351% |
| Blue Cross Blue Shield | $54 - $57 | 358% |
| Aetna | $74 - $117 | 491% |
| First Health - All Plans | $74 - $117 | 491% |
| Cigna | $78 - $124 | 517% |
| Coventry Mcaid-All Plans | $82 - $130 | 544% |
| Healthy Blue Mcaid- All Other Plans | $82 - $130 | 544% |
| Medicaid / KanCare | $82 - $130 | 544% |
| Providers Care-Wppa-All Plans | $123 - $195 | 816% |
Consumer Guidance & Cost Commentary
For the blood test for vitamin B12 at Ellsworth County Medical Center, the cash price is $106.00, which matches the facility's median paid amount. This cash rate is significantly lower than the negotiated rates charged to insurance plans, which range from $39 to $195 depending on the payer. For instance, while some payers like Va Ccn-All Plans and Triwest have negotiated rates as low as $39, others such as Providers Care-Wppa-All Plans have rates up to $195. Patients with high-deductible plans may find paying the $106 cash price directly more cost-effective than relying on insurance, especially since the median negotiated rate across all payers is $80.00, which is higher than the cash price. It is important to verify your specific plan's allowed amount before scheduling, as in-network rates vary widely even within the same facility.
The facility's pricing is evaluated against the Medicare benchmark of $15.08, showing a markup of 5.3 times the Medicare rate, which is consistent with typical commercial pricing structures where rates often exceed 200% of Medicare. To minimize costs, patients should inquire about "self-pay" or "prompt-pay" discounts before check-in, as these can reduce the bill by 20% to 50% by bypassing administrative claim processing fees. Additionally, if you receive a bill from an out-of-network provider at this in-network facility, you may be entitled to protections under the No Surprises Act, which prevents balance billing for emergency or non-emergency services. Always request a full itemized bill to ensure no unbundled codes or