Blood test, complete blood count (CBC)
Facility: Trego County Lemke Memorial Hospital
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $18
- Cash Discount Price: $18
- vs. Medicare Baseline: 2.32x 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 232% of the Medicare baseline (a markup of 132%). 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 |
|---|---|---|
| Va Ccn - All Plans | $2 | 26% |
| Humana | $10 | 129% |
| Tricare | $11 | 142% |
| UnitedHealthcare | $13 - $21 | 167% |
| Medicaid / KanCare | $13 - $21 | 167% |
| Aetna | $13 - $19 | 167% |
| Ambetter / Centene | $14 | 180% |
| Blue Cross Blue Shield | $18 | 232% |
| Health Partners - All Plans | $20 | 257% |
| Healthy Blue Mcaid - All Plans | $21 | 270% |
Consumer Guidance & Cost Commentary
For the complete blood count (CBC) test at Trego County Lemke Memorial Hospital, the cash price of $18.00 is lower than the facility's negotiated rates, which average $18.00 across payers like Humana and UnitedHealthcare. While the hospital is a Critical Access Hospital in Wakeeney, KS, with a government-local ownership structure, patients should be aware that paying cash upfront can often result in a lower total cost than using insurance, especially if their plan has a high deductible or if the negotiated rate exceeds the cash price. Since the facility is a Critical Access Hospital, it may offer specific "self-pay" or "prompt-pay" discounts for upfront billing, which can bypass the administrative overhead and higher negotiated ceilings typically associated with commercial insurance contracts.
When evaluating this price against federal standards, the Medicare benchmark for this service is $7.77, which serves as the objective baseline for fair pricing. The facility's cash rate of $18.00 represents a significant markup compared to the Medicare amount, illustrating the difference between the government's cost-based reimbursement and commercial pricing. It is important to note that while commercial negotiated rates often range from 200% to 300% of Medicare, fair pricing is generally considered to be between 120% and 150% of the Medicare rate. Patients should request an itemized bill to ensure no errors exist and verify their specific plan's deductible status before scheduling, as paying the full negotiated rate without meeting the deductible can lead to unexpected out-of-pocket expenses.