CMS Price Transparency Data

Blood test, vitamin B12

Facility: Hospital for Special Surgery

Billing Code: 82607 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 82607
Insurance Median: $111
Cash Discount Price: $197
vs. Medicare Baseline: 7.36x Medicare

The contracted insurance negotiated median rate for a Blood test, vitamin B12 at Hospital for Special Surgery is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $197. Compared to the federal Medicare reimbursement reference rate of $15.08, this hospital’s rate is 7.36x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$197

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$15.08

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $15.08 (100%)

Cash / Self-Pay: $197 (1306%)

Insurance Median: $111 (736%)

Cash: $197 (1306% of Medicare)

Ins. Median: $111 (736% of 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 736% of the Medicare baseline (a markup of 636%). 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
UnitedHealthcare	$17 - $155	113%
Fidelis Essential [1323]	$28 - $76	186%
Blue Cross Blue Shield	$30 - $191	199%
Aetna	$76 - $111	504%
Affinity By Molina Health Plan [1005]	$76 - $122	504%
Christian Brothers [1034]	$76 - $111	504%
Connecticare [1039]	$76 - $151	504%
Emblem Health [1043]	$76 - $151	504%
Harvard Pilgrim [1057]	$76 - $155	504%
Medicare (plans)	$76	504%
Meritain Health [1085]	$76 - $111	504%
Nippon Life [1092]	$76 - $111	504%
Oxford [1096]	$76 - $105	504%
Student Resources [1103]	$76 - $128	504%
Webtpa [1356]	$76 - $111	504%
Geha [1053]	$128	849%
Apwu [1016]	$129 - $144	855%
Cigna	$129 - $144	855%
Nalc [1090]	$129 - $144	855%
Qualcare [1101]	$129 - $144	855%
Wellfleet [1361]	$129 - $144	855%

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 $197.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 82607.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Hospital for Special Surgery is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 82607.
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.