Blood test, hemoglobin
Facility: Decatur Health
Billing Code: 85018 (CPT)
- CPT Billing Code: 85018
- Insurance Median: $14
- Cash Discount Price: $16
- 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 |
|---|---|---|
| Humana | $11 | 464% |
| Wppa/Providrs Care- All Plans | $11 | 464% |
| UnitedHealthcare | $11 - $14 | 464% |
| Blue Cross Blue Shield | $13 | 549% |
| Aetna | $16 - $18 | 675% |
| Midlands Choice- All Plans | $16 | 675% |
| Medicaid / KanCare | $18 | 759% |
Consumer Guidance & Cost Commentary
For this blood test for hemoglobin at Decatur Health in Oberlin, Kansas, the cash price is $16.00, which is slightly lower than the facility's negotiated rates with major payers like UnitedHealthcare and Aetna. While the median amount paid by insurers is $12.00, patients with high-deductible plans may find the cash price more advantageous if their insurance allows a higher negotiated rate than the cash amount. It is important to note that the facility's cash rate is $16.00, which is $3.63 higher than the Medicare benchmark of $2.37, reflecting the standard markup for commercial services.
To minimize unexpected costs, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront payment options can reduce the final bill. Additionally, if you receive a bill from an out-of-network provider or unexpected ancillary services at this in-network facility, you may be subject to balance billing, though the No Surprises Act protects you from such charges for emergency and non-emergency care at in-network hospitals. Always request a detailed, itemized bill to review specific CPT codes and avoid paying for services not rendered or charges that were incorrectly bundled.