Blood test, complete blood count (CBC)
Facility: Kansas Heart Hospital
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $8
- Cash Discount Price: $28
- 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 |
|---|---|---|
| Aetna | $3 | 39% |
| Tricare | $7 | 90% |
| Celtic Mcr Adv | $8 | 103% |
| UnitedHealthcare | $8 | 103% |
| Humana | $8 | 103% |
| Medicaid / KanCare | $8 | 103% |
| Blue Cross Blue Shield | $9 | 116% |
| Wppa - All Plans | $18 | 232% |
| Multiplan - All Plans | $40 | 515% |
Consumer Guidance & Cost Commentary
For the complete blood count (CBC) test at Kansas Heart Hospital in Wichita, KS, the facility's cash price of $28.00 is significantly lower than the state average of $44.00 and the Medicare benchmark of $7.77. While the hospital's negotiated rates with major payers like Aetna, UnitedHealthcare, and Tricare range from $8.00 to $29.00, patients with high-deductible plans may find the cash price more advantageous if their insurance allows a higher negotiated rate than the cash amount. It is important to note that while the facility offers a cash rate, commercial insurance contracts often include administrative overhead that can inflate the baseline price, making direct cash payment a potentially more efficient option for those without active coverage.
Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, though unexpected ancillary charges can still occur if specific lab services are out-of-network. To ensure full transparency, consumers should request an itemized billing audit before paying any invoice, as summary bills often obscure individual code costs and potential errors. Additionally, if you choose to pay out-of-pocket, ask the billing department about "self-pay" or "prompt-pay" discounts, which can further reduce the cost by bypassing the administrative fees associated with insurance claims processing.