Blood test, hemoglobin

For the CPT code 85018, representing a blood test for hemoglobin, Mercy Specialty Hospital Southeast Kansas lists a gross charge of $38.00. This amount is significantly higher than the facility's own cash median of $25.00 and exceeds the state average by 9.3%. While the facility offers a negotiated rate of $22.00 for commercial payers, which is lower than the gross charge, patients should be aware that cash-pay options can sometimes be more economical, particularly for those with high-deductible plans where the insurance negotiated rate might exceed the cash price. To secure the lowest possible cost, patients are encouraged to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid in full upfront.

It is important to distinguish between the facility's gross charges and the actual amounts paid by insurance. The data indicates that while Medicare reimburses $2.37 for this service, commercial payers negotiate rates ranging from $2 to $41 depending on the specific insurer and plan. Because commercial negotiated rates often include administrative overhead and are not bound by the same cost constraints as Medicare, they can appear higher than the cash price. If a patient receives a bill that includes charges above the negotiated rate, they may be facing balance billing, which is generally prohibited for out-of-network services at in-network facilities under the No Surprises Act. Patients should request a detailed, itemized bill to verify that all services rendered were accurately coded and that no unexpected ancillary charges were included before agreeing to pay.