Blood test, complete blood count (CBC)
Facility: Rooks County Health Center
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $21
- Cash Discount Price: $23
- 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 |
|---|---|---|
| Veterans Admin - All Plans | $2 - $14 | 26% |
| Blue Cross Blue Shield | $13 | 167% |
| Celtic Mcr Adv | $14 | 180% |
| Tricare | $14 | 180% |
| Celtic Comm - All Other Plans | $16 | 206% |
| Preferred Benefits Admin | $27 | 347% |
| UnitedHealthcare | $27 | 347% |
| Aetna | $27 | 347% |
| Preferred Hlthcare - All Other Plans | $28 | 360% |
| Health Partners - All Plans | $28 | 360% |
| Healthy Blue Mcaid - All Plans | $30 | 386% |
Consumer Guidance & Cost Commentary
For the complete blood count (CBC) test at Rooks County Health Center in Plainville, Kansas, the facility's cash price of $23.00 is lower than the state average of $30.00 and significantly below the gross chargemaster rate of $30.00. While the facility's negotiated rates with major payers like Blue Cross Blue Shield and UnitedHealthcare range from $13.00 to $28.00, these amounts are often higher than the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find paying the cash price of $23.00 upfront more cost-effective than relying on insurance, which could result in a negotiated rate exceeding the cash amount. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront incentives can further reduce the final cost.
When using insurance, patients should be aware that commercial rates are frequently marked up compared to the Medicare benchmark of $7.77, which serves as a scientifically validated baseline for the true cost of care. Although the facility is a Critical Access Hospital owned by a Government Hospital District, the negotiated rates reflect the administrative complexity of claims processing and utilization reviews. To avoid unexpected balance billing, patients should verify their network status before scheduling, as out-of-network services—even at in-network facilities—can sometimes trigger additional charges unless protected by federal laws like the No Surprises Act. If a bill arrives, consumers should request a detailed itemized audit to identify any unbundled codes or services not rendered, ensuring they are only paying for the actual care received.