Blood test, hemoglobin
Facility: Nemaha Valley Community Hospital
Billing Code: 85018 (CPT)
- CPT Billing Code: 85018
- Insurance Median: $20
- Cash Discount Price: $26
- vs. Medicare Baseline: 8.44x 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 844% of the Medicare baseline (a markup of 744%). 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 | $13 - $25 | 549% |
| Humana | $13 | 549% |
| Celtic Comm Exch - All Plans | $14 | 591% |
| Partners Direct Health - All Plans | $15 | 633% |
| Multiplan - All Plans | $26 | 1097% |
| Midlands Choice - All Plans | $28 | 1181% |
| Health Partners - All Plans | $28 | 1181% |
Consumer Guidance & Cost Commentary
For the blood test for hemoglobin (CPT 85018) at Nemaha Valley Community Hospital in Seneca, KS, the facility's cash median price is $26.00, which is lower than the state average of $29.00. While commercial insurance carriers negotiate rates that typically cap the cost for in-network members, these negotiated amounts often exceed the cash price due to administrative overhead and contract structures. For example, the median negotiated rate across payers is $20.00, though individual plans like Aetna and Humana have specific ranges starting at $13.00. Patients with high-deductible plans may find it financially advantageous to pay the cash price of $26.00 directly, as this avoids potential out-of-pocket costs if their insurance deductible has not yet been met or if the negotiated rate for their specific plan is higher than the cash option.
To ensure you are receiving the best possible rate, it is important to verify your specific plan's allowed amount before scheduling the test, as in-network rates can vary significantly between providers. Additionally, ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront, bypassing the administrative costs associated with insurance claims. When reviewing your final invoice, request a detailed itemized bill to check for errors or unbundled charges, as over 80% of hospital bills contain mistakes that can be corrected. Finally, compare the facility's pricing to the Medicare benchmark of $2.37 for this service; while commercial rates are naturally higher, understanding this baseline helps identify if the negotiated or cash rates are