Blood test, hemoglobin
Facility: Graham County Hospital
Billing Code: 85018 (CPT)
- CPT Billing Code: 85018
- Insurance Median: $14
- Cash Discount Price: $19
- vs. Medicare Baseline: 5.91x 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 591% of the Medicare baseline (a markup of 491%). 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 |
|---|---|---|
| Medicaid / KanCare | $3 | 127% |
| UnitedHealthcare | $3 - $21 | 127% |
| Blue Cross Blue Shield | $10 | 422% |
| Medicare (plans) | $11 - $17 | 464% |
| Celtic Commercial-All Other Plans | $12 - $19 | 506% |
| Wppa (Providers Care)-All Plans | $14 - $21 | 591% |
Consumer Guidance & Cost Commentary
For this blood test procedure at Graham County Hospital in Hill City, Kansas, the cash price is $19.00, which matches the facility's median negotiated rate. While the hospital is in-network for six major payers including Medicaid, UnitedHealthcare, and Medicare, the actual amount paid by insurance varies significantly. Medicare allows only $2.37 for this service, while Medicaid and UnitedHealthcare plans negotiate rates ranging from $3.00 to $21.00 depending on the specific plan. Because the cash price of $19.00 is lower than the negotiated rates for many commercial payers, patients with high-deductible plans or those who have already met their out-of-pocket maximum may save money by paying cash directly, provided they confirm the facility offers a self-pay discount.
It is important to note that commercial insurance rates are often inflated by administrative costs and contract structures, sometimes exceeding the true cost of care represented by Medicare benchmarks. For instance, while the Medicare allowed amount is $2.37, the median negotiated rate across all payers is $14.00. Patients should be aware that balance billing is generally prohibited for emergency services and non-emergency care at in-network facilities under the No Surprises Act, though unexpected charges can still occur if ancillary services like lab tests are billed by out-of-network providers. To ensure you are not overcharged, always request an itemized bill before paying and verify that all services listed were actually rendered, as summary bills often hide errors or unbundled charges that could be disputed.