Blood test, complete blood count (CBC)
Facility: St Luke Hospital & Living Center
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $48
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 6.18x 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 618% of the Medicare baseline (a markup of 518%). 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 | $48 | 618% |
| UnitedHealthcare | $48 | 618% |
| Ambetter / Centene | $48 | 618% |
| Bluestem Pace | $48 | 618% |
| Kansas Department Of Health And Environment | $48 | 618% |
| Va Ccn | $48 | 618% |
| Humana | $48 | 618% |
Consumer Guidance & Cost Commentary
For the complete blood count (CBC) test at St Luke Hospital & Living Center in Marion, KS, the commercial negotiated rate is $48.00, which matches the lowest and highest amounts reported across all seven payers, including Blue Cross Blue Shield, UnitedHealthcare, and Humana. This negotiated rate is significantly lower than the facility's gross charge of $94.00, reflecting the contractual caps that protect in-network members from balance billing. While the facility is a Critical Access Hospital owned by a Government Hospital District, the data does not provide specific cash or self-pay rates; however, patients with high-deductible plans should verify if paying cash directly could result in a lower out-of-pocket cost than their insurance allowed amount, as commercial negotiated rates often exceed cash prices due to administrative overhead.
The facility's pricing is also notable when compared to federal benchmarks, with the Medicare amount set at $7.77. This establishes a baseline for fair pricing, as commercial rates are typically marked up significantly above this figure. Although the data does not list specific state or county average comparisons for this CPT code, the consistent $48.00 negotiated rate across all listed payers suggests a standardized pricing structure for this service within the region. Consumers are advised to request a formal itemized bill before payment to ensure no unbundled codes or services not rendered are included, and to inquire about prompt-pay discounts if they choose to settle the account directly with the hospital.