Blood test, complete blood count (CBC)
Facility: Nmc Health
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $24
- Cash Discount Price: $52
- vs. Medicare Baseline: 3.09x 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 309% of the Medicare baseline (a markup of 209%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $13 | 167% |
| Wppa | $14 - $67 | 180% |
| Aetna | $15 - $101 | 193% |
| Occunet | $16 - $73 | 206% |
| Samaritan Ministries International | $17 - $79 | 219% |
| Medincrease Health Plan | $17 - $79 | 219% |
| Prime Health Services | $20 - $92 | 257% |
| UnitedHealthcare | $23 - $110 | 296% |
| Cigna | $25 - $116 | 322% |
Consumer Guidance & Cost Commentary
For the complete blood count (CBC) test at Nmc Health in Newton, KS, the facility's cash price of $52.00 is significantly higher than the state average, which is approximately $16.00. While commercial insurance plans like Blue Cross Blue Shield and Wppa negotiate rates ranging from $13 to $67, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to note that commercial rates can vary widely by payer, with UnitedHealthcare and Cigna negotiating rates up to $116, so verifying your specific plan's allowed amount before scheduling is essential to avoid unexpected costs.
The facility's negotiated rate of $24.00 sits below the gross charge of $122.00 but remains above the Medicare benchmark of $7.77, reflecting a markup common in the healthcare industry. To potentially lower your bill, patients should inquire about "self-pay" or "prompt-pay" discounts, which can reduce the total cost by 20% to 50% if paid upfront. Additionally, since over 80% of hospital bills contain errors, requesting a detailed, itemized statement before payment allows you to identify any unbundled codes or services not rendered, ensuring you are only paying for what was actually provided.