Blood test, complete blood count (CBC)
Facility: Decatur Health
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $25
- Cash Discount Price: $29
- vs. Medicare Baseline: 3.22x 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 322% of the Medicare baseline (a markup of 222%). 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 | $17 | 219% |
| Wppa/Providrs Care- All Plans | $19 | 245% |
| Humana | $20 | 257% |
| UnitedHealthcare | $20 - $25 | 257% |
| Aetna | $29 - $32 | 373% |
| Midlands Choice- All Plans | $29 | 373% |
| Medicaid / KanCare | $33 | 425% |
Consumer Guidance & Cost Commentary
For this complete blood count (CBC) test at Decatur Health in Oberlin, Kansas, the facility's cash price of $29.00 is slightly higher than the state average of $22.00. While commercial insurance plans like Blue Cross Blue Shield and WPPA/Providers Care have negotiated rates of $17.00 and $19.00 respectively, these figures often represent the maximum allowed amount rather than the actual out-of-pocket cost for patients. It is important to note that for individuals with high-deductible plans who have not yet met their coverage threshold, paying the cash price of $29.00 upfront may be more cost-effective than relying on insurance, which could result in a higher total charge if the negotiated rate exceeds the cash price. Patients should verify their specific deductible status and ask the facility directly about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full before or shortly after the service.
When evaluating the cost of this procedure, it is helpful to compare the facility's pricing against the Medicare benchmark, which stands at $7.77 for this code. The facility's cash rate of $29.00 represents a significant markup over the federal government's calculated cost, a common practice in the healthcare industry where commercial rates often average 200% to 300% of the Medicare amount. To ensure you are receiving fair pricing, we recommend requesting an itemized billing audit to confirm that all charges are accurate and that no services were unbundled or billed twice. If you receive a surprise bill from an out-of-network provider, such