Blood test, hemoglobin
Facility: St Luke Hospital & Living Center
Billing Code: 85018 (CPT)
- CPT Billing Code: 85018
- Insurance Median: $20
- Cash Discount Price: Unavailable
- 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 |
|---|---|---|
| Ambetter / Centene | $20 | 844% |
| Kansas Department Of Health And Environment | $20 | 844% |
| Humana | $20 | 844% |
| Bluestem Pace | $20 | 844% |
| Va Ccn | $20 | 844% |
| Blue Cross Blue Shield | $20 | 844% |
| UnitedHealthcare | $20 | 844% |
Consumer Guidance & Cost Commentary
For this blood test service at St Luke Hospital & Living Center in Marion, KS, the commercial negotiated rate is $20.00, which aligns with the state average for this procedure. This rate is significantly lower than the facility's gross charge of $39.00, demonstrating the value of in-network agreements. However, patients should be aware that commercial negotiated rates often include administrative overhead and may exceed the actual cost of care. In cases where a patient has a high deductible or no insurance, paying the cash price could be more economical, as commercial rates are frequently inflated compared to direct payment options. It is crucial to verify your specific plan's deductible status before scheduling, as paying the negotiated rate without meeting your deductible can result in unexpected out-of-pocket expenses.
When evaluating the cost of this service, it is important to compare it against the Medicare benchmark rather than the hospital's full list price. The Medicare amount for this code is $2.37, and the facility's rate is 8.4 times higher than this federal baseline, which is well above the typical fair pricing range of 120% to 150% of Medicare. This markup reflects the commercial nature of the rate, which includes provider work, practice expenses, and malpractice insurance. To minimize costs, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront. Additionally, requesting a detailed itemized bill is essential to ensure no errors, such as unbundled codes or charges for services not rendered, are included in the final amount.