Blood test, complete blood count (CBC)
Facility: Ellinwood District Hospital
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $21
- Cash Discount Price: $26
- vs. Medicare Baseline: 2.70x 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 270% of the Medicare baseline (a markup of 170%). 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 | $9 - $33 | 116% |
| Cigna | $9 - $33 | 116% |
| Humana | $9 - $33 | 116% |
| Blue Cross Blue Shield | $9 - $33 | 116% |
| Aetna | $9 - $33 | 116% |
Consumer Guidance & Cost Commentary
For this blood test at Ellinwood District Hospital, the cash price is $26.00, which is lower than the facility's negotiated rates of $21.00 and the median paid by insurers at $17.00. While the cash price is higher than the Medicare benchmark of $7.77, it is important to note that commercial negotiated rates often include administrative overhead and can exceed cash prices for patients with high deductibles. In this specific case, the cash rate is actually the most affordable option for self-pay patients, as paying directly avoids the administrative markup embedded in insurance contracts. Patients should verify their specific plan details, as some high-deductible policies may result in out-of-pocket costs that exceed the $26.00 cash price if the insurer's allowed amount is higher.
To ensure you are not overcharged, we recommend requesting an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, if you are receiving care from an out-of-network provider, the No Surprises Act protects you from balance billing for emergency services and non-emergency services at in-network facilities. If you choose to pay out-of-network, ask the hospital about prompt-pay discounts, which can reduce the total cost by 20% to 50% if settled upfront. Always confirm whether your specific test is covered under your plan and check for any self-pay or prompt-pay discounts available before scheduling your appointment.