Blood test, complete blood count (CBC)
Facility: Susan B Allen Memorial Hospital
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $554
- Cash Discount Price: $11
- vs. Medicare Baseline: 71.30x 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 $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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 7130% of the Medicare baseline (a markup of 7030%). 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 |
|---|---|---|
| UnitedHealthcare | $350 | 4505% |
| Providrs Care | $757 | 9743% |
Consumer Guidance & Cost Commentary
For the complete blood count (CBC) test at Susan B Allen Memorial Hospital in El Dorado, KS, the facility's cash median price is $11.00, which is significantly lower than the negotiated rates of $350.00 for UnitedHealthcare and $757.00 for Providrs Care. This substantial difference highlights how commercial insurance contracts often result in much higher out-of-pocket costs for patients compared to self-pay options. While the facility's cash rate is the most transparent figure available, patients should verify if their specific insurance plan has a deductible that would require them to pay the full negotiated amount before any coverage applies.
To minimize costs, patients should proactively ask the hospital about "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid upfront, bypassing the administrative overhead of insurance claims. Additionally, since the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients can dispute any unexpected charges by requesting a formal itemized audit rather than paying immediately. Given that Medicare benchmarks this service at $7.77, the cash price of $11.00 represents a fair market value, whereas the negotiated rates far exceed typical fair pricing standards.