CMS Price Transparency Data

Blood test, complete blood count (CBC)

Facility: Wilcox Memorial Hospital

Billing Code: 85025 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85025
Insurance Median: $11
Cash Discount Price: $44
vs. Medicare Baseline: 1.42x Medicare

The contracted insurance negotiated median rate for a Blood test, complete blood count (CBC) at Wilcox Memorial Hospital is $11. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $44. Compared to the federal Medicare reimbursement reference rate of $7.77, this hospital’s rate is 1.42x the Medicare baseline. Located in 3-3420 Kuhio Highway, Lihue, HI.

Cash / Self-Pay

$44

Average discount available for prompt cash payment at this facility.

Insurance Median

$11

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$7.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $7.77 (100%)

Cash / Self-Pay: $44 (566%)

Insurance Median: $11 (142%)

Cash: $44 (566% of Medicare)

Ins. Median: $11 (142% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $7.77 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
Alohacare	$8 - $11	103%
Devoted	$8	103%
Hmsa	$8 - $17	103%
Mdx	$8 - $9	103%
Ohana	$8 - $21	103%
UnitedHealthcare	$11	142%
Pac Admin	$12	154%
Hcha	$16	206%
Hwmg/Hmaa	$20	257%
Uha	$20	257%
Verdegard	$20	257%
Kaiser	$57 - $59	734%
Multiplan	$57 - $63	734%

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 $44.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 85025.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Wilcox Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 85025.
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.