Blood test, complete blood count (CBC)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $39
- Cash Discount Price: $41
- vs. Medicare Baseline: 5.02x 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 502% of the Medicare baseline (a markup of 402%). 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 |
|---|---|---|
| Tricare | $33 | 425% |
| Humana | $37 | 476% |
| Aetna | $38 - $41 | 489% |
| UnitedHealthcare | $39 | 502% |
| Hpk-All Plans | $39 | 502% |
| Medicaid / KanCare | $41 | 528% |
Consumer Guidance & Cost Commentary
For patients paying out of pocket, the most important fact to know is that the cash price for this blood test is $41.00, which serves as the baseline for self-pay rates. While many patients assume insurance offers the lowest cost, this specific service is priced at $41.00 for cash, which is notably higher than the median negotiated rate of $39.00 and the median paid rate of $38.00. This pricing structure highlights a scenario where paying cash directly might actually be more expensive than using an in-network plan, as the insurance negotiated rate is lower than the cash charge.
When comparing this facility's pricing to the broader market, Medicine Lodge Memorial Hospital's cash rate of $41.00 aligns exactly with the statewide average for this procedure, as the cash median across Kansas is also $41.00. However, it is important to note that this facility is a government-owned Critical Access Hospital, which often influences its pricing model. Patients should verify with the hospital whether "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront payment incentives can sometimes reduce the final bill below the standard cash price. Additionally, since the Medicare amount for this service is $7.77, commercial rates are significantly higher than the federal benchmark, reflecting the administrative overhead and contractual dynamics typical of commercial insurance networks.