CMS Price Transparency Data

Blood test, hemoglobin

Facility: Kenmore Mercy Hospital

Billing Code: 85018 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85018
Insurance Median: $2
Cash Discount Price: $11
vs. Medicare Baseline: 0.84x Medicare

The contracted insurance negotiated median rate for a Blood test, hemoglobin at Kenmore Mercy Hospital is $2. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $11. Compared to the federal Medicare reimbursement reference rate of $2.37, this hospital’s rate is 0.84x the Medicare baseline. Located in 2950 Elmwood Avenue, Kenmore, NY.

Cash / Self-Pay

$11

Average discount available for prompt cash payment at this facility.

Insurance Median

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: $11 (464%)

Insurance Median: $2 (84%)

Cash: $11 (464% of Medicare)

Ins. Median: $2 (84% 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.

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
UnitedHealthcare	$1 - $2	42%
VA Veterans Affairs [700001]	$1 - $2	42%
Catholic Health Life Pace [400005]	$2	84%
Federal Workers Compensation [500100]	$2 - $6	84%
Humana	$2	84%
Independent Health [100165]	$2	84%
Covid19 Hrsa [45013]	$2	84%
Excellus Rochester McD [350117]	$2	84%
Molina Essential [100167]	$2 - $5	84%
Univera Healthcare Essential [100170]	$2	84%
Fidelis Dual Advantage [450120]	$2	84%
Iha First Choice [800001]	$2	84%
Tuscarora Nation [550120]	$2	84%
Beacon Essential [350122]	$2	84%
Medicaid / KanCare	$2	84%
Vna Option Mltc [350110]	$2	84%
Blue Cross Blue Shield	$2 - $5	84%
Wellcare [450129]	$2 - $3	84%
Wellcare Fidelis Dual [450451]	$2	84%
Fallon Health [450115]	$2	84%
Univera Healthcare [100169]	$2 - $4	84%
Champ VA [700002]	$2	84%
Medicare (plans)	$2	84%
Hospice [550001]	$2	84%
Aetna	$2	84%
Cigna	$2	84%
Crime Victims [100176]	$2	84%
Independent Health Essential [100166]	$2	84%
Seneca Nation [450119]	$2	84%
Tricare	$2	84%
Fidelis Exchange [100164]	$3 - $4	127%
Fidelis Essential [100163]	$3 - $5	127%
Amerigroup [350102]	$5	211%
No Fault [114001]	$6	253%

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 $11.
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 Kenmore Mercy Hospital 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.