Blood test, hemoglobin
Facility: Stormont Vail Hospital
Billing Code: 85018 (CPT)
- CPT Billing Code: 85018
- Insurance Median: $8
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.38x 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 338% of the Medicare baseline (a markup of 238%). 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 |
|---|---|---|
| UnitedHealthcare | $2 | 84% |
| Ambetter / Centene | $2 | 84% |
| Blue Cross Blue Shield | $2 - $10 | 84% |
Consumer Guidance & Cost Commentary
For the blood test code 85018 at Stormont Vail Hospital in Topeka, KS, the facility's negotiated rate is $8.00, which is significantly lower than the state average of $4206.00. While the facility's cash rate is not listed, patients with high-deductible plans should be aware that paying cash upfront can sometimes result in a lower total cost than using insurance, as commercial negotiated rates often exceed cash prices due to administrative overhead. To secure the best possible price, it is recommended to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid in full before or shortly after the service.
This service is benchmarked against Medicare, which pays $2.37 for this procedure, indicating that the facility's negotiated rate is approximately 3.4 times the Medicare amount. Although the facility is an in-network provider for UnitedHealthcare, Ambetter/Centene, and Blue Cross Blue Shield, patients should verify their specific plan details to ensure they are not subject to balance billing for out-of-network ancillary services, such as emergency physicians or lab components, even when receiving care at an in-network hospital. If a surprise bill is received, consumers should dispute it in writing with the insurer rather than paying immediately, as federal protections under the No Surprises Act may apply to out-of-network providers at in-network facilities.