Hi everyone,
Every now and then, the cost of lab tests comes up here in the forum – particularly the tests that are critical for diagnosing multiple myeloma. By those I mean the serum protein electrophoresis, serum immunofixation electrophoresis, and serum free light chain assay.
After Mrozdav asked about this earlier today, it got me wondering, and I decided to do a little research. I also thought I'd create a new thread where I can share what I found out and others can post costs that they've seen on their bills, posted on the internet, or elsewhere. We can start out with the three tests that I mentioned above, but can add other tests later, such as immunoglobulin level tests, metabolic panels, etc.
We also can start with costs here in the U.S., but can add the costs elsewhere, if people can find that information.
When I started looking into this, I quickly found that people use what Medicare is willing to pay for tests as a guide to what they usually cost for insurance companies. So that's what I looked for and, after a bit of legwork, that's what I found.
I'll give the numbers first, then explain where I got them, including the meaning of the "CPT" codes that I list.
Serum Protein Electrophoresis (With Total Protein)
Maximum Medicare will pay: $19.60
Average that labs bill: $26.49
(CPT codes 84165 and 84155)
Serum Immunofixation Electrophoresis
Maximum Medicare will pay: $30.41
Average that labs bill: $41.09
(CPT code 86334)
Serum Free Light Chain Assay
Maximum Medicare will pay: $37.00
Average that labs bill: $50.00
(CPT code 83883 x 2)
I got these numbers by first downloading from the Medicare website an Excel spreadsheet with the "2015 Clinical Diagnostic Laboratory Fee Schedule." The spreadsheet lists the "National Limit" for what Medicare will pay for a test, which I've used to calculate "Maximum Medicare will pay" numbers up above.
The spreadsheet also gives what is called a "National Midpoint" cost. As I understand it, this is what lab companies bill for tests, on average, and it is usually (always?) more than the maximum Medicare will pay. I included that number as the "Average that labs bill" cost estimate above.
The lab test costs in the Medicare Excel spreadsheet are organized by "CPT" code. These are just codes to make it easy for lab companies to request Medicare reimbursement for tests that they do. It is not easy to find out what codes match up with what test, but this document came in handy for figuring that out, as did some checking at the Quest Diagnostics website, which also lists CPT codes for tests.
There's a lot that we can discuss about these numbers, but this is already a long post, so I will stop now and wait to answer any questions that come up. I do hope this information will be helpful both now and in the future.
Forums
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Re: Cost of multiple myeloma lab tests
Cheryl,
This is a great idea. I'm happy to share what Quest Diagnostics and my hospital billed for all the key labs and services and what Aetna's negotiated rates (these are not Medicare rates) are.
Lab Test Description CPT Code What Quest Aetna Member
Billed Rate Cost
SPEP 84165 $48.01 $9.56 Varies
IFE 86334 $205.23 $19.90 Varies
Free Light Chain Assay 82883x2 $323.40 $24.22 Varies
Quantified Immunoglobulins 82784 $175.39 $24.84 Varies
CBC 85025 $40.56 $6.19 Varies
Comp Metabolic Panel 80053 $67.16 $8.41 Varies
Beta2 Microglobulin 82232 $133.22 $14.41 Varies
Imaging & BMB Description CPT Code What Hospital Aetna Member
Billed Rate Cost
DEXA Scan 77085 $43.00 $15.61 Varies
PET/CT 77816 $4,120.00 $2,500.00 Varies
Skeletal Survey N/A $1,424.00 $713.00 Varies
Bone Marrow Biopsy &
Associated Tests Misc $18,679.00 $8,151.00 Varies
This is a great idea. I'm happy to share what Quest Diagnostics and my hospital billed for all the key labs and services and what Aetna's negotiated rates (these are not Medicare rates) are.
Lab Test Description CPT Code What Quest Aetna Member
Billed Rate Cost
SPEP 84165 $48.01 $9.56 Varies
IFE 86334 $205.23 $19.90 Varies
Free Light Chain Assay 82883x2 $323.40 $24.22 Varies
Quantified Immunoglobulins 82784 $175.39 $24.84 Varies
CBC 85025 $40.56 $6.19 Varies
Comp Metabolic Panel 80053 $67.16 $8.41 Varies
Beta2 Microglobulin 82232 $133.22 $14.41 Varies
Imaging & BMB Description CPT Code What Hospital Aetna Member
Billed Rate Cost
DEXA Scan 77085 $43.00 $15.61 Varies
PET/CT 77816 $4,120.00 $2,500.00 Varies
Skeletal Survey N/A $1,424.00 $713.00 Varies
Bone Marrow Biopsy &
Associated Tests Misc $18,679.00 $8,151.00 Varies
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Cost of multiple myeloma lab tests
Thanks for starting this thread, Cheryl, and for sharing the information you found. And thanks as well, Multibilly, for putting up the additional information you shared.
If anyone else has similar information they have found or can share, feel free to post it, and don't worry about the format of the information. We can reformat whatever you post so that it looks similar to what Cheryl and Multibilly posted (which we also reformatted).
If anyone else has similar information they have found or can share, feel free to post it, and don't worry about the format of the information. We can reformat whatever you post so that it looks similar to what Cheryl and Multibilly posted (which we also reformatted).
Re: Cost of multiple myeloma lab tests
Thought I'd add another data point to this:
Venipuncture $62
IgG $94
IgA $94
IgM $94
Free kappa $20
Free lambda $20
Total prot $18
Prot Elec $18
Comp Metabolic Panel $390
CBC with diff $80
Total $890
Aetna covers $641
My cost $249
The comp metabolic panel seems high, no?
Venipuncture $62
IgG $94
IgA $94
IgM $94
Free kappa $20
Free lambda $20
Total prot $18
Prot Elec $18
Comp Metabolic Panel $390
CBC with diff $80
Total $890
Aetna covers $641
My cost $249
The comp metabolic panel seems high, no?
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Entropy - Who do you know with myeloma?: Me (MGUS)
- When were you/they diagnosed?: April 2016
- Age at diagnosis: 48
Re: Cost of multiple myeloma lab tests
Wow, that does seem awfully costly for a comprehensive metabolic panel. I've checked labs that allow customers to order their own tests, and it seems most of them charge $30-$40 for a CMP. And that's the total cost, as these labs don't take insurance and you're expected to pay for everything out of pocket.
Re: Cost of multiple myeloma lab tests
I had every intention of building on what Multibilly started. It just ain't that easy, for me. I could only find one code that matched his. Even though I had a whole body MRI, they broke it down into sections (head, thoracic, legs, etc). Then that appears broken in two - one for the actual test, and another for the radiologist to read. The same for the PET/CT and pharmacy charge for the radioactive juice, and I'm sure the glucose test and IV line is somewhere.
Testing in Aug 2016
Lab Test CPT Billed Humana
Description Code Allowed
SPEP 84165 $41.00 $28.80
I would still be interested in providing my data, but I'm not sure anybody wants us to figure it out. In fact, I'll go out on a limb and say they don't want me to figure it out.
Testing in Aug 2016
Lab Test CPT Billed Humana
Description Code Allowed
SPEP 84165 $41.00 $28.80
I would still be interested in providing my data, but I'm not sure anybody wants us to figure it out. In fact, I'll go out on a limb and say they don't want me to figure it out.
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blueblood - Name: Craig
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 54
Re: Cost of multiple myeloma lab tests
btdyq5,
I wonder if they meant $39 for the CMP.
It's labeled a CCCMP for presumably Cancer Center Complete Metabolic Panel.
EDIT#1: I looked at my identical lab work from June 2016 and the accepted Aetna Rate was $239 for all the testing and their accepted rate for the CMP was $42. I just didn't pay much attention in June because I was over my deductible and coinsurance for the year.
I wonder if they meant $39 for the CMP.
It's labeled a CCCMP for presumably Cancer Center Complete Metabolic Panel.
EDIT#1: I looked at my identical lab work from June 2016 and the accepted Aetna Rate was $239 for all the testing and their accepted rate for the CMP was $42. I just didn't pay much attention in June because I was over my deductible and coinsurance for the year.
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Entropy - Who do you know with myeloma?: Me (MGUS)
- When were you/they diagnosed?: April 2016
- Age at diagnosis: 48
Re: Cost of multiple myeloma lab tests
The local hospital charged $970. BCBS knocked that total out of pocket cost down to $673. The hospital did not break out individual costs.
I found that you can order some of the tests online, which may cost much less. However, at least as far as I've found so far, you can't get the very important kappa/lambda free light chains test. Here's some example online (self-pay) costs:
IGM 99
Basic Metabolic Panel (BMP8) Blood Test
$26.00
Complete Blood Count (CBC) with Differential and Platelets Blood Test
$28.00
Protein Electrophoresis Serum Test
$57.00
Immunofixation (IFE) Serum Test
$229.00
Immunoglobulins Blood Test, Quantitative, IgA, IgG and IgM
$99.00
Subtotal: $439
Discount: -$43.90
Grand Total: $395.10
I found that you can order some of the tests online, which may cost much less. However, at least as far as I've found so far, you can't get the very important kappa/lambda free light chains test. Here's some example online (self-pay) costs:
IGM 99
Basic Metabolic Panel (BMP8) Blood Test
$26.00
Complete Blood Count (CBC) with Differential and Platelets Blood Test
$28.00
Protein Electrophoresis Serum Test
$57.00
Immunofixation (IFE) Serum Test
$229.00
Immunoglobulins Blood Test, Quantitative, IgA, IgG and IgM
$99.00
Subtotal: $439
Discount: -$43.90
Grand Total: $395.10
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jyh - Name: Jim
- Who do you know with myeloma?: Me (MGUS)
- When were you/they diagnosed?: 2013
- Age at diagnosis: 53
Re: Cost of multiple myeloma lab tests
Just an FYI: All tests, surgeries, visits have a CPT code that must be used when any provider bills for outpatient or inpatient services. The CPT code book is published yearly by the AMA. I have the book, as I do coding work and can provide the exact description of a code if you need one.
As far as costs go, every healthcare provider sets their own fees but then has contractual rates they entered in to with the payers that the provider accepts as payment.
The hospital may bill $100.00 for a test, but accepts $25 from one payer, $21 from another payer etc. it’s all based on contracts.
So what they actually receive will be different from one payer to another based on those contracts. Hospitals and health care providers, if they have contracted with Medicare, take the payment and must write off the remainder. Your copay is determined by your provider.
Hope this helps.
As far as costs go, every healthcare provider sets their own fees but then has contractual rates they entered in to with the payers that the provider accepts as payment.
The hospital may bill $100.00 for a test, but accepts $25 from one payer, $21 from another payer etc. it’s all based on contracts.
So what they actually receive will be different from one payer to another based on those contracts. Hospitals and health care providers, if they have contracted with Medicare, take the payment and must write off the remainder. Your copay is determined by your provider.
Hope this helps.
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Kellyd
Re: Cost of multiple myeloma lab tests
My CT scan, aspirate and biopsy cost €500. Regular bloods (I always insist on every conceivable test) €40. This is for everyone, regardless of whether you have / don't have private insurance. I have private health insurance, but I had to pay €120 towards the CT/A & biopsy.
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Colm - Name: Colm
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: smoldering April 2016
- Age at diagnosis: 56
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