Blood test, hemoglobin
Facility: Trego County Lemke Memorial Hospital
Billing Code: 85018 (CPT)
- CPT Billing Code: 85018
- Insurance Median: $13
- Cash Discount Price: $13
- 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 |
|---|---|---|
| Humana | $7 - $8 | 295% |
| Tricare | $8 | 338% |
| Medicaid / KanCare | $9 - $16 | 380% |
| Aetna | $9 - $14 | 380% |
| UnitedHealthcare | $9 - $16 | 380% |
| Ambetter / Centene | $10 - $11 | 422% |
| Blue Cross Blue Shield | $13 | 549% |
| Health Partners - All Plans | $14 - $15 | 591% |
| Healthy Blue Mcaid - All Plans | $15 - $16 | 633% |
Consumer Guidance & Cost Commentary
For the blood test procedure (CPT 85018) at Trego County Lemke Memorial Hospital in Wakeeney, KS, the facility's cash median rate is $13.00, while the median negotiated rate for insured patients is $13.00. This specific service is benchmarked against a Medicare amount of $2.37, indicating that both cash and negotiated rates are significantly higher than the federal baseline. The facility, a Critical Access Hospital with government-local ownership, lists a gross charge of $16.00. While the data does not provide explicit county or state average figures for this specific code, the substantial markup over the Medicare rate highlights the importance of understanding the difference between the facility's list price and the actual amounts paid by insurers.
Patients should be aware that paying cash upfront may offer financial advantages depending on their specific insurance plan and deductible status. Although the cash and negotiated rates are identical in this instance, hospitals often offer prompt-pay discounts of 20% to 50% for those who settle bills immediately, bypassing the administrative costs associated with insurance claims processing. It is crucial to request self-pay or prompt-pay rates before scheduling services and to avoid automatic claims submission if you intend to pay out-of-pocket. Additionally, since the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients should verify their network status and ensure they do not sign away rights to dispute out-of-network charges for ancillary services like laboratory tests.