CMS Price Transparency Data

Blood test, vitamin B12

Facility: UPMC Presbyterian Shadyside

Billing Code: 82607 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 82607
Insurance Median: $131
Cash Discount Price: $1,168
vs. Medicare Baseline: 8.69x Medicare

The contracted insurance negotiated median rate for a Blood test, vitamin B12 at UPMC Presbyterian Shadyside is $131. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,168. Compared to the federal Medicare reimbursement reference rate of $15.08, this hospital’s rate is 8.69x the Medicare baseline. Located in 200 Lothrop Street, Pittsburgh, PA.

Cash / Self-Pay

$1,168

Average discount available for prompt cash payment at this facility.

Insurance Median

$131

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: $1,168 (7745%)

Insurance Median: $131 (869%)

Cash: $1,168 (7745% of Medicare)

Ins. Median: $131 (869% 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 869% of the Medicare baseline (a markup of 769%). 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
Health Partners Plans (Jefferson Health Plan)	$13	86%
Upmc Health Plan	$14 - $22	93%
Upmc Work Partners	$15	99%
Amerihealth Caritas	$16 - $21	106%
Cigna	$16	106%
Highmark Wholecare (Prev Gateway)	$16 - $19	106%
Pa Health & Wellness	$16 - $22	106%
UnitedHealthcare	$16	106%
Aetna	$17	113%
Multiplan	$17 - $1,558	113%
Geisinger	$20	133%
Blue Cross Blue Shield	$29 - $131	192%
Preferred Healthcare System	$1,266	8395%
Coventry/First Health	$1,363	9038%
Fidelis	$1,460	9682%
Intergroup	$1,460 - $1,655	9682%
Health Coalition Partners	$1,558	10332%
Private Health Care Systems	$1,558	10332%
Selectcare	$1,558	10332%
Health Payors Organization	$1,655	10975%
Humana	$1,655	10975%

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 $1,168.
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 Presbyterian Shadyside 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.