Blood test, hemoglobin
Facility: Hiawatha Community Hospital
Billing Code: 85018 (CPT)
- CPT Billing Code: 85018
- Insurance Median: $13
- Cash Discount Price: $21
- vs. Medicare Baseline: 5.49x 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 549% of the Medicare baseline (a markup of 449%). 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 | $5 - $23 | 211% |
| UnitedHealthcare | $5 - $24 | 211% |
| Humana | $5 - $10 | 211% |
| Ambetter / Centene | $6 - $12 | 253% |
| Blue Cross Blue Shield | $9 - $10 | 380% |
| Centrus Health Direct - All Plans | $10 - $21 | 422% |
| Oscar - All Plans | $10 - $21 | 422% |
| Preferred Hlth - All Plans | $13 - $25 | 549% |
| Cigna | $13 - $27 | 549% |
| Wppa Providrs Care - All Plans | $13 - $27 | 549% |
| Multiplan - All Plans | $14 - $27 | 591% |
| Healthy Blue Mcaid - All Plans | $14 - $28 | 591% |
| Midlands Choice - All Plans | $14 - $27 | 591% |
Consumer Guidance & Cost Commentary
For this blood test procedure at Hiawatha Community Hospital, the cash price is $21.00, which matches the facility's cash median. While the hospital is a Critical Access Hospital in Kansas, the data does not provide specific state or county average rates for comparison. It is important to note that commercial insurance negotiated rates often exceed cash prices due to administrative costs and contract structures; however, patients with high-deductible plans may find paying the cash price directly more affordable than having their insurance apply a negotiated rate that exceeds the cash amount. Before scheduling, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront, bypassing the higher administrative fees associated with insurance billing cycles.
The facility's negotiated rates range from $5 to $28 across 13 different payers, with the median negotiated amount being $13.00. This figure represents the maximum amount insurance carriers are contractually allowed to pay, which is often lower than the cash price but may still result in significant out-of-pocket costs if the patient has not yet met their deductible. To ensure you are not overpaying, it is recommended to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. Additionally, while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, patients should carefully review any consent waivers to ensure their rights regarding surprise billing are preserved.