Blood test, hemoglobin
Facility: Pratt Regional Medical Center
Billing Code: 85018 (CPT)
- CPT Billing Code: 85018
- Insurance Median: $19
- Cash Discount Price: $16
- vs. Medicare Baseline: 8.02x 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 $2.37 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 802% of the Medicare baseline (a markup of 702%). 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 |
|---|---|---|
| Christian Health Aid | $8 - $26 | 338% |
| UnitedHealthcare | $9 - $35 | 380% |
| Health Partners Of Kansas | $9 - $29 | 380% |
| Aetna | $10 - $31 | 422% |
| Choicecare | $11 - $34 | 464% |
Consumer Guidance & Cost Commentary
For this blood test at Pratt Regional Medical Center in Pratt, KS, the facility's cash price of $16.00 is notably lower than the state average, which sits at $23.00. While commercial insurance plans like UnitedHealthcare and Aetna negotiate rates ranging from $9 to $35, these figures often exceed the cash price. For patients with high-deductible plans, paying the cash price directly can be more cost-effective than relying on insurance, as the negotiated rates may not cover the full cost of the service. It is important to verify your specific plan's allowed amount before scheduling, as some in-network contracts may result in higher out-of-pocket costs compared to self-pay options.
To ensure you are not overcharged, always request an itemized bill that breaks down the specific CPT code and unit costs, as summary bills can hide errors or unbundled charges. Additionally, ask the billing department about "prompt-pay" discounts, which can reduce the final amount if you settle the balance upfront, bypassing the administrative fees associated with insurance claims. Since Medicare rates for this service are set at $2.37, any commercial rate significantly higher than this reflects the facility's markup; comparing your final bill against the Medicare benchmark provides a clear view of the true cost versus the negotiated price.