Blood test, complete blood count (CBC)
Facility: Cloud County Health Center
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $51
- Cash Discount Price: $38
- vs. Medicare Baseline: 6.56x 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 656% of the Medicare baseline (a markup of 556%). 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 |
|---|---|---|
| Aetna | $18 - $69 | 232% |
| Health Partners - All Plans | $19 - $70 | 245% |
| Mpi-All Plans | $19 - $70 | 245% |
| Pponext-All Plans | $19 - $70 | 245% |
Consumer Guidance & Cost Commentary
For the complete blood count (CBC) test at Cloud County Health Center in Concordia, KS, the facility's cash price of $38.00 is lower than the state average of $51.00. While the facility's negotiated rate with major payers like Aetna and Health Partners is $51.00, patients with high-deductible plans or those without insurance may find the cash price more advantageous. It is important to note that commercial insurance rates often include administrative overhead and do not reflect the true cost of care; comparing these negotiated rates to the Medicare benchmark of $7.77 reveals a significant markup. To potentially lower your out-of-pocket costs, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final amount owed.
Patients should be aware of balance billing risks, particularly if any ancillary services or specific lab components are provided by out-of-network providers, which could trigger unexpected bills for the difference between the allowed amount and the full charge. Although the No Surprises Act protects emergency and non-emergency services at in-network facilities, it is still prudent to request an itemized bill to verify that no unbundled codes or services not rendered have been included. If a summary bill is received, consumers should demand a full, line-by-line statement to identify any errors or double-charges, as over 80% of hospital bills contain mistakes that can be corrected through a formal written audit dispute. By understanding these billing dynamics and verifying rates against the Medicare benchmark, patients can make informed decisions and avoid unnecessary financial burdens.