Blood test, hemoglobin
Facility: Children'S Mercy South
Billing Code: 85018 (CPT)
- CPT Billing Code: 85018
- Insurance Median: $18
- Cash Discount Price: $13
- vs. Medicare Baseline: 7.59x 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 759% of the Medicare baseline (a markup of 659%). 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 |
|---|---|---|
| Healthy Blue | $2 - $6 | 84% |
| Medicaid / KanCare | $2 | 84% |
| UnitedHealthcare | $2 - $19 | 84% |
| Home State Health | $6 | 253% |
| Blue Cross Blue Shield | $11 - $21 | 464% |
| Cigna | $13 - $19 | 549% |
| Medica | $16 | 675% |
| Aetna | $17 - $19 | 717% |
| Orscheln | $18 | 759% |
| Health Midwest Comprehensive Care | $18 | 759% |
| Quiktrip | $18 | 759% |
| Centivo | $18 | 759% |
| Wppa Providrs Care | $18 | 759% |
| Wellfit/Centrus | $18 | 759% |
| Nebraska Furniture Mart | $18 | 759% |
| Humana | $19 | 802% |
| Coxhealth Network | $21 | 886% |
| Multiplan | $21 | 886% |
| Mercy Health | $21 | 886% |
| Coventry Health Care Of Kansas | $21 | 886% |
| American Healthcare Alliance | $24 | 1013% |
| National Preferred Provider Network | $25 | 1055% |
| Healthlink | $25 | 1055% |
Consumer Guidance & Cost Commentary
For the blood test procedure (CPT 85018) at Children's Mercy South in Overland Park, KS, the facility's cash median price is $13.00, which is significantly lower than the state average of $18.00. While many commercial payers have negotiated rates ranging from $18.00 to $28.00, patients with high-deductible plans may find paying the cash price directly more cost-effective, as the cash rate is often lower than the insurer's allowed amount. It is important to note that commercial negotiated rates frequently exceed cash prices due to administrative overhead and contract dynamics, so verifying the specific cash or "self-pay" rate before scheduling can help avoid unexpected costs.
The facility's pricing is also evaluated against the Medicare benchmark, where the Medicare amount for this service is $2.37. The cash price of $13.00 represents a markup of 7.6 times the Medicare rate, which falls within the typical range for commercial pricing where rates often average 200% to 300% of Medicare. If you receive a bill that includes charges for out-of-network ancillary services or emergency care at this in-network facility, you may be protected under the No Surprises Act, which bans balance billing for these specific scenarios. To ensure you are not overcharged, always request a full itemized bill before paying and dispute any errors in writing, as over 80% of hospital bills contain mistakes that can be corrected through a formal audit.