CMS Price Transparency Data

Blood test, vitamin B12

Facility: UPMC Northwest

Billing Code: 82607 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 82607
Insurance Median: $68
Cash Discount Price: $89
vs. Medicare Baseline: 4.51x Medicare

The contracted insurance negotiated median rate for a Blood test, vitamin B12 at UPMC Northwest is $68. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $89. Compared to the federal Medicare reimbursement reference rate of $15.08, this hospital’s rate is 4.51x the Medicare baseline. Located in 100 Fairfield Drive, Seneca, PA.

Cash / Self-Pay

$89

Average discount available for prompt cash payment at this facility.

Insurance Median

$68

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: $89 (590%)

Insurance Median: $68 (451%)

Cash: $89 (590% of Medicare)

Ins. Median: $68 (451% 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 451% of the Medicare baseline (a markup of 351%). 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
Upmc Health Plan	$14 - $21	93%
Blue Cross Blue Shield	$15 - $93	99%
Geisinger	$15	99%
UnitedHealthcare	$15 - $17	99%
Upmc Work Partners	$15	99%
Aetna	$16 - $97	106%
Amerihealth Caritas	$16 - $20	106%
Highmark Wholecare (Prev Gateway)	$16 - $19	106%
Pa Health & Wellness	$16 - $22	106%
Cigna	$60 - $97	398%
Intergroup	$97 - $3,704	643%
Coventry/First Health	$104	690%
Health Coalition Partners	$107	710%
Private Health Care Systems	$119	789%
Humana	$127	842%

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 $89.
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 UPMC Northwest 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.