Blood test, complete blood count (CBC)
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $12
- Cash Discount Price: $94
- vs. Medicare Baseline: 1.54x 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 |
|---|---|---|
| United Medical Resources Contracted [320454] | $6 - $21 | 77% |
| UnitedHealthcare | $6 - $134 | 77% |
| Humana | $7 - $8 | 90% |
| First Health Contracted [320128] | $7 | 90% |
| Medica Contracted [320239] | $7 | 90% |
| Aetna | $7 - $8 | 90% |
| Blue Cross Blue Shield | $7 - $10 | 90% |
| Medicaid / KanCare | $7 - $11 | 90% |
| Tricare | $8 | 103% |
| Dept Of Veteran Affairs Contracted [320106] | $8 | 103% |
| Cross Timbers Hospice [20098] | $8 | 103% |
| Mercy Mgd Behavioral Health Contracted [320259] | $8 | 103% |
| Kindful Hospice [20434] | $8 | 103% |
| Globalhealth Contracted [320145] | $8 | 103% |
| Medical Associates Health Contracted [320444] | $8 | 103% |
| Halo Hcr Inc Hospice [20432] | $8 | 103% |
| Provider Partners Health Plans Contracted [320450] | $8 | 103% |
| Qual Choice Contracted [320325] | $8 | 103% |
| Elara Caring Aspire Hospice [20433] | $8 | 103% |
| Mercy Hospice Okc [20252] | $8 | 103% |
| Cherokee Nation Health Serv Contracted [320066] | $8 | 103% |
| Cigna | $8 - $45 | 103% |
| Kindful Hospice Contracted [320434] | $8 | 103% |
| Pace Of The Ozarks Contracted [320518] | $8 | 103% |
| Medicare (plans) | $8 | 103% |
| Halo Hcr Inc Hospice Contracted [320432] | $8 | 103% |
| Centivo Contracted [320505] | $13 | 167% |
| Providrs Care Network Contracted [320484] | $15 | 193% |
| Insurance System Inc Contracted [320465] | $21 | 270% |
| Healthscope Contracted [320182] | $21 - $109 | 270% |
| Point C Contracted [320238] | $21 - $109 | 270% |
| Health Systems Inc Contracted [320174] | $21 | 270% |
| Benefit Management Contracted [320052] | $21 | 270% |
| Mercy Benefit Admin Contracted [320251] | $48 - $102 | 618% |
| Show-Me Health Administrators Contracted [320483] | $48 | 618% |
| Aither Health Contracted [320449] | $102 | 1313% |
| American Healthcare Alliance Contracted [320020] | $102 | 1313% |
| Imagine 360 Contracted [320494] | $102 | 1313% |
| Edison Health Solutions Contracted [320502] | $102 | 1313% |
| Yuzu Health Contracted [320521] | $102 | 1313% |
| Auxiant Contracted [320462] | $102 - $109 | 1313% |
| Reflect Health Contracted [320492] | $102 | 1313% |
| Ebms Contracted [320493] | $102 | 1313% |
| Preferred Health Plan Contracted [320522] | $109 | 1403% |
| Federal Medical Center Contracted [320127] | $109 | 1403% |
| Healthlink Contracted [320179] | $109 | 1403% |
| Compcare Of The Ozarks Contracted [320437] | $115 | 1480% |
| Workers Comp [20426] | $116 | 1493% |
| Private Health Care Systems Contracted [320320] | $134 | 1725% |
| Multiplan [20270] | $138 | 1776% |
| Multiplan Contracted [320270] | $138 | 1776% |
Consumer Guidance & Cost Commentary
For the complete blood count (CBC) test at Mercy Specialty Hospital Southeast Kansas, the facility's cash price of $94.00 is significantly lower than the median negotiated rate of $12.00 reported across 51 payers, though this comparison highlights that insurance contracts often include administrative overhead that can inflate the final allowed amount. While the facility's cash rate is higher than the state-wide cash median of $94.00, patients with high-deductible plans may find that paying out-of-pocket upfront is more cost-effective than relying on insurance, as the negotiated rates for many commercial payers range from $6 to $134, with some plans potentially paying far less than the cash price after deductibles are applied. To maximize savings, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the bill by 20% to 50% by bypassing costly claims processing and administrative fees.
The facility's Medicare benchmark of $7.77 serves as a critical baseline, indicating that the cash price of $94.00 represents a markup of approximately 1.5 times the federal reimbursement rate, which aligns with the typical range of 120% to 150% considered fair for commercial pricing. 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, unexpected charges can still occur if ancillary services like specific lab components are billed separately; therefore, patients should always request a full, itemized bill before payment to identify any unbundled codes or services not rendered. Given that over 80% of