Blood test, hemoglobin
Facility: Smith County Memorial Hospital
Billing Code: 85018 (CPT)
- CPT Billing Code: 85018
- Insurance Median: $24
- Cash Discount Price: $26
- vs. Medicare Baseline: 10.13x 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 1013% of the Medicare baseline (a markup of 913%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $10 | 422% |
| Medicaid / KanCare | $18 - $26 | 759% |
| Multiplan-All Plans | $23 | 970% |
| Wppa-All Plans | $24 | 1013% |
| Health Partners Of Ks Ppo-All Plans | $25 | 1055% |
| Midlands Choice-All Plans | $25 | 1055% |
| UnitedHealthcare | $25 | 1055% |
Consumer Guidance & Cost Commentary
For this blood test service at Smith County Memorial Hospital, the cash price of $26.00 is significantly lower than the average negotiated rates paid by insurance plans, which range from $18.00 to $26.00 depending on the carrier. While the facility's cash rate matches the highest negotiated amounts seen in this data, patients with high-deductible plans or those who have already met their out-of-pocket limits may find paying the cash price directly more cost-effective than relying on insurance, which often results in higher allowed amounts due to administrative overhead. It is important to note that while the facility is a government-owned Critical Access Hospital in Smith Center, KS, the cash rate remains competitive compared to the broader market, though patients should always verify if "self-pay" or "prompt-pay" discounts are available before scheduling to ensure they are receiving the lowest possible fee.
The data also reveals that the facility's cash rate is 10.1% higher than the Medicare benchmark of $2.37, illustrating how commercial pricing structures can differ significantly from federal cost baselines. Although the facility has no published rating, the transparency of these rates allows consumers to understand that while insurance contracts cap charges at various levels between $10.00 and $26.00, the actual cost to a self-pay patient is fixed at $26.00. Consumers should be aware that balance billing is generally prohibited for emergency services at in-network facilities under federal law, but for non-emergency tests like this one, it is crucial to confirm the facility's network status and request an itemized bill to avoid unexpected charges. If a patient receives a bill that exceeds the cash price or Medicare rate, they