Blood test, complete blood count (CBC)
Facility: Kiowa District Hospital
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $47
- Cash Discount Price: $40
- vs. Medicare Baseline: 6.05x 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 605% of the Medicare baseline (a markup of 505%). 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 |
|---|---|---|
| Healthchoice-All Plans | $12 | 154% |
| Blue Cross Blue Shield | $13 | 167% |
| Tricare | $20 | 257% |
| UnitedHealthcare | $40 - $50 | 515% |
| Health Partners Of Ks-All Plans | $44 | 566% |
| Humana | $45 | 579% |
| Gbs Insurance - All Plans | $47 | 605% |
| Multiplan-All Plans | $47 | 605% |
| Aetna | $48 | 618% |
| Triwest-All Plans | $48 | 618% |
| Medicare (plans) | $48 | 618% |
| Medicaid / KanCare | $50 | 644% |
| Providers Care (Wppa)-All Plans | $75 | 965% |
| Liberty Healthshare-All Plans | $81 | 1042% |
Consumer Guidance & Cost Commentary
For the complete blood count (CBC) test at Kiowa District Hospital, the cash price is $40.00, which is lower than the facility's negotiated rates of $47.00 and the Medicare benchmark of $7.77. While commercial payers like UnitedHealthcare and UnitedHealthcare negotiate rates ranging from $40.00 to $50.00, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount exceeds $40.00. It is important to note that the facility is a Critical Access Hospital in Kiowa, Kansas, and while specific county or state average data was not provided in this report, the cash rate remains a fixed baseline that can be compared against any out-of-network or self-pay estimates.
Patients should be aware that insurance negotiated rates often include administrative overhead and do not always represent the lowest possible cost for the service. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to verify that all ancillary services, such as specific lab components, are covered under the same network agreement. To minimize costs, consumers are encouraged to contact the hospital directly to inquire about self-pay discounts or prompt-pay incentives, which can reduce the bill by 20% to 50% if paid in full upfront. Additionally, if a patient receives an itemized bill, they should request a detailed audit to ensure no unbundled codes or services not rendered have inflated the total charge.