Blood test, hemoglobin
Facility: William Newton Hospital
Billing Code: 85018 (CPT)
- CPT Billing Code: 85018
- Insurance Median: $9
- Cash Discount Price: $23
- vs. Medicare Baseline: 3.80x 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 380% of the Medicare baseline (a markup of 280%). 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 | $8 - $9 | 338% |
| Ambetter / Centene | $8 - $23 | 338% |
| UnitedHealthcare | $8 - $21 | 338% |
| Triwest- All Plans | $8 | 338% |
| Providrs Care Nexus | $14 | 591% |
| Providrs Care - All Other Plans | $16 | 675% |
Consumer Guidance & Cost Commentary
For this blood test at William Newton Hospital in Winfield, KS, the cash price is $23.00, which matches the facility's cash median. This rate is significantly higher than the state average, as indicated by a 3.8x markup compared to Medicare's benchmark of $2.37. While commercial insurance plans like Blue Cross Blue Shield and UnitedHealthcare negotiate rates ranging from $8.00 to $23.00, patients with high-deductible plans might find paying cash directly more cost-effective if their insurance negotiated rate exceeds the cash price. It is important to note that the facility is a Critical Access Hospital owned by the local government, and patients should verify their specific plan's allowed amount before scheduling to ensure they are not facing unexpected balance billing, though the No Surprises Act protects against such charges for out-of-network services at in-network facilities.
To minimize costs, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront. Since hospitals often issue summary bills that obscure individual charges, consumers are advised to request a full itemized CPT-coded statement before paying to identify any errors, unbundled codes, or services not rendered. Disputing billing mistakes should be done in writing to ensure corrections are properly recorded, rather than relying on verbal assurances. By comparing the facility's rates directly to the Medicare benchmark and seeking out prompt-pay incentives, patients can avoid overpaying and ensure they are receiving fair pricing for this essential laboratory service.