Blood test, complete blood count (CBC)
Facility: Rawlins County Health Center
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $29
- Cash Discount Price: $31
- vs. Medicare Baseline: 3.73x 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 373% of the Medicare baseline (a markup of 273%). 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 | $13 | 167% |
| UnitedHealthcare | $29 - $35 | 373% |
Consumer Guidance & Cost Commentary
For a complete blood count (CBC) at Rawlins County Health Center in Atwood, Kansas, the cash price is $31.00, which is lower than the facility's negotiated rate of $29.00 and significantly below the Medicare benchmark of $7.77. While commercial insurance plans like Blue Cross Blue Shield and UnitedHealthcare have negotiated rates ranging from $13 to $35, these amounts often exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash rate directly, as the $31.00 fee is lower than the insurer's allowed amount, potentially saving money on out-of-pocket costs.
To maximize savings, patients should verify if the facility offers self-pay or prompt-pay discounts, which can reduce the bill by 20% to 50% for upfront payment. It is important to request a waiver of insurance submission before check-in to prevent automatic claims that could void these cash discounts. Additionally, while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should always request a detailed, itemized bill rather than accepting a summary invoice. This ensures that no unbundled codes or services not rendered are included, allowing for an accurate audit of the final charge against the stated cash or negotiated rates.