CMS Price Transparency Data

Blood test, hemoglobin

Facility: Cook Childrens Medical Center Prosper

Billing Code: 85018 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85018
Insurance Median: $25
Cash Discount Price: $51
vs. Medicare Baseline: 10.55x Medicare

The contracted insurance negotiated median rate for a Blood test, hemoglobin at Cook Childrens Medical Center Prosper is $25. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $51. Compared to the federal Medicare reimbursement reference rate of $2.37, this hospital’s rate is 10.55x the Medicare baseline. Located in 4100 W University Drive, Prosper, TX.

Cash / Self-Pay

$51

Average discount available for prompt cash payment at this facility.

Insurance Median

$25

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$2.37

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $2.37 (100%)

Cash / Self-Pay: $51 (2152%)

Insurance Median: $25 (1055%)

Cash: $51 (2152% of Medicare)

Ins. Median: $25 (1055% of 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 1055% of the Medicare baseline (a markup of 955%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Beacon	$2 - $36	84%
El Paso Health First	$2 - $36	84%
Health Plan W. Uhrip	$2	84%
Health Plan W/O Uhrip	$2 - $36	84%
Tx Children Health	$2 - $36	84%
Wellpoint	$2	84%
Aetna	$3 - $57	127%
Blue Cross Blue Shield	$3 - $61	127%
Firstcare	$3 - $54	127%
Superior Health	$3	127%
United Community	$3 - $25	127%
UnitedHealthcare	$30 - $57	1266%
Cigna	$57	2405%
Healthscope	$57	2405%
Imagine Health	$57	2405%
S&W Health	$57	2405%
First Health	$59	2489%
Humana	$59	2489%
Multiplan	$59	2489%
Galaxy Health	$61	2574%
Healthsmart	$61	2574%
Usamco	$62	2616%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $51.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 85018.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Cook Childrens Medical Center Prosper is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 85018.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.