Blood test, complete blood count (CBC)
Facility: Lmh
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $31
- Cash Discount Price: $34
- vs. Medicare Baseline: 3.99x 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 399% of the Medicare baseline (a markup of 299%). 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 | $7 - $225 | 90% |
| Blue Cross Blue Shield | $7 - $143 | 90% |
| Humana | $8 - $221 | 103% |
| Allwell | $8 | 103% |
| Cigna | $8 - $221 | 103% |
| Medicare (plans) | $8 - $221 | 103% |
| Haskell Indian Health Services | $8 | 103% |
| Aetna | $9 - $184 | 116% |
| Ambetter / Centene | $12 - $13 | 154% |
| Non Contracted | $41 - $177 | 528% |
| First Health | $48 - $206 | 618% |
Consumer Guidance & Cost Commentary
For this complete blood count (CBC) test at Lmh in Lawrence, KS, the cash price is $34.00, which is significantly lower than the facility's gross charge of $136.00. While the facility is in-network for most major payers, the negotiated rates vary widely, ranging from $7 to $225 depending on the insurance plan. Notably, the cash price of $34.00 is lower than the median negotiated rate of $31.00 reported for this service, suggesting that patients with high-deductible plans or those without immediate insurance coverage might save money by paying cash upfront. To maximize savings, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as hospitals often offer additional reductions for upfront payment that are not automatically applied during insurance billing.
The facility's pricing is also evaluated against federal benchmarks; the Medicare amount for this procedure is $7.77, and the facility's cash rate is approximately 4.0 times the Medicare amount. This comparison highlights that while the cash price is higher than the government baseline, it remains substantially below the gross chargemaster list price. Patients should be aware that balance billing is generally prohibited for in-network services under the No Surprises Act, but it is crucial to verify that the specific lab service is covered by the plan and to avoid signing waivers that could inadvertently allow out-of-network billing for ancillary services. Always request a detailed, itemized bill to ensure no unbundled charges or services not rendered are included in the final invoice.