Blood test, complete blood count (CBC)
Facility: Providence Medical Center
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $8
- Cash Discount Price: $7
- vs. Medicare Baseline: 1.03x 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.
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 - $13 | 90% |
| Celtic | $7 - $12 | 90% |
| Healthy Blue | $7 - $8 | 90% |
| Medicaid / KanCare | $7 | 90% |
| Aetna | $7 - $14 | 90% |
| Tricare | $8 | 103% |
| Midland Care Connection | $8 | 103% |
| Kansas Superior Select | $8 | 103% |
| Blue Cross Blue Shield | $8 - $19 | 103% |
| Medicare (plans) | $8 | 103% |
| Cigna | $8 | 103% |
| Corizon | $10 | 129% |
| Well Path Prison | $11 | 142% |
| Employer Direct Healthcare | $11 | 142% |
| Centurion | $12 | 154% |
| Naphcare | $12 | 154% |
| Comp Alliance - Fka Compresults Worker Compensation | $16 | 206% |
| Oha Networks | $17 | 219% |
| Worker Compensation | $18 | 232% |
Consumer Guidance & Cost Commentary
For CPT code 85025, a complete blood count (CBC) at Providence Medical Center in Kansas City, KS, the cash median price is $7.00, which is significantly lower than the facility's negotiated rates and the Medicare benchmark of $7.77. While the facility is a voluntary non-profit acute care hospital, patients should be aware that commercial insurance plans often pay negotiated rates ranging from $7 to $19 depending on the carrier, with some plans like UnitedHealthcare and Celtic paying between $7 and $13. Because cash prices can sometimes be lower than what insurance negotiates, individuals with high-deductible plans may save money by paying the cash rate directly, provided they verify the facility's "self-pay" or "prompt-pay" discounts before scheduling. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients must still confirm their specific plan's allowed amount to avoid unexpected costs.
To ensure you are receiving the most accurate pricing, always request an itemized billing audit rather than accepting a summary bill, as hospitals may obscure individual code costs in broad categories. Comparing your specific plan's negotiated rate to the Medicare benchmark of $7.77 can reveal if the commercial rate is appropriately marked up, as fair pricing is typically defined as 120% to 150% of Medicare, whereas commercial rates often average 200% to 300%. If you receive a bill that appears inflated, do not settle verbally; instead, send a formal written dispute to the billing supervisor to address errors such as unbundled codes or services not rendered. Finally, remember