Blood test, complete blood count (CBC)
Facility: Ashland Health Center
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $32
- Cash Discount Price: $48
- vs. Medicare Baseline: 4.12x 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 412% of the Medicare baseline (a markup of 312%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $7 - $33 | 90% |
| Compalliance-All Plans | $16 - $79 | 206% |
| Health Partners Of Kansas-All Plans | $17 - $84 | 219% |
| Medicare (plans) | $20 - $99 | 257% |
| Medica Mcare - All Plans | $20 - $99 | 257% |
| Healthy Blue Mcr Adv - All Other Plans | $20 - $99 | 257% |
| UnitedHealthcare | $20 - $99 | 257% |
| Health Choice-All Plans | $20 - $99 | 257% |
| Multiplan-All Plans | $20 - $97 | 257% |
| Aetna | $20 - $99 | 257% |
| Medicaid / KanCare | $20 - $99 | 257% |
| Providers Care (Wppa)-All Plans | $30 - $148 | 386% |
Consumer Guidance & Cost Commentary
For the complete blood count (CBC) test at Ashland Health Center in Ashland, KS, the facility's cash price of $48.00 is lower than the state average of $60.00, making it a cost-effective option for self-pay patients. While the median negotiated rate across 12 payers is $32.00, commercial insurance plans often pay significantly more than the cash price due to administrative overhead and contract structures; for instance, UnitedHealthcare and Aetna plans have negotiated rates reaching up to $99.00. This dynamic suggests that patients with high-deductible plans or those without insurance may save money by paying the cash price directly, provided they confirm the facility offers a self-pay or prompt-pay discount to avoid balance billing.
The facility's Medicare benchmark of $7.77 serves as a baseline for fair pricing, with the cash rate representing a markup of approximately 62% above this federal standard, which aligns with the typical 120% to 150% range considered fair for commercial pricing. To ensure you are not overcharged, it is recommended to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. If you receive a bill that includes out-of-network ancillary services, you may be eligible for protections under the No Surprises Act, which prohibits balance billing for emergency and non-emergency care at in-network facilities, so you should dispute any unexpected charges in writing rather than accepting summary invoices.