Blood test, hemoglobin
Facility: Nmc Health
Billing Code: 85018 (CPT)
- CPT Billing Code: 85018
- Insurance Median: $21
- Cash Discount Price: $24
- vs. Medicare Baseline: 8.86x 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 886% of the Medicare baseline (a markup of 786%). 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 |
|---|---|---|
| Aetna | $7 - $38 | 295% |
| Blue Cross Blue Shield | $10 | 422% |
| Wppa | $12 - $25 | 506% |
| Occunet | $13 - $28 | 549% |
| Medincrease Health Plan | $14 - $30 | 591% |
| Samaritan Ministries International | $14 - $30 | 591% |
| Prime Health Services | $17 - $35 | 717% |
| UnitedHealthcare | $20 - $41 | 844% |
| Cigna | $21 - $44 | 886% |
Consumer Guidance & Cost Commentary
For the blood test code 85018 at Nmc Health in Newton, KS, the cash price of $24.00 is significantly lower than the facility's gross charge of $34.00. While the facility's negotiated rates with insurance payers range from $7.00 to $44.00, the cash price often provides a better value for patients with high-deductible plans or those without insurance, as it bypasses the administrative overhead and contract markups inherent in commercial billing. It is important to note that commercial negotiated rates frequently exceed cash prices due to the costs of claims processing and utilization reviews, meaning paying out-of-pocket upfront can sometimes result in a lower total cost than relying on an insurance network.
When evaluating this price against broader benchmarks, the Medicare rate of $2.37 serves as the objective baseline for the true cost of this service, highlighting that commercial rates are typically marked up significantly above this federal standard. The facility's cash price of $24.00 is 8.9 times the Medicare amount, which falls within the typical range where commercial rates average 200% to 300% of Medicare, though fair pricing is often defined as 120% to 150%. Patients should verify their specific plan's deductible status before scheduling, as paying the negotiated rate may be required if the deductible has not been met, and they should explicitly request a "self-pay" or "prompt-pay" discount at registration to ensure they are not being billed the full insurance allowed amount.