Blood test, complete blood count (CBC)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $15
- Cash Discount Price: $29
- vs. Medicare Baseline: 1.93x 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.
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 | $11 - $25 | 142% |
| Blue Cross Blue Shield | $13 | 167% |
| UnitedHealthcare | $14 - $19 | 180% |
Consumer Guidance & Cost Commentary
For this blood test procedure at Community Memorial Healthcare, Inc., the cash price of $29.00 is identical to the facility's median negotiated rate of $15.00, which is lower than the state average of $29.00. While the facility's cash rate matches the gross charge, patients with high-deductible plans may find paying out-of-pocket cheaper than using insurance, as the negotiated rate paid by insurers is significantly higher than the cash price. It is important to note that this facility is a Critical Access Hospital in Marysville, KS, and while the cash rate is competitive, patients should always verify if "self-pay" or "prompt-pay" discounts are available before scheduling to ensure they are receiving the lowest possible fee.
The Medicare benchmark for this service is $7.77, which serves as a baseline for evaluating the facility's pricing markup. The facility's cash rate of $29.00 is 1.9 times the Medicare amount, reflecting the standard administrative and operational costs associated with commercial billing. If a patient receives care from an out-of-network provider or encounters unexpected ancillary services, they could face balance billing for the difference between the allowed amount and the full charge, though the No Surprises Act protects against surprise bills for emergency care at in-network facilities. To avoid errors, patients should request a detailed, itemized bill rather than accepting a summary invoice, as over 80% of hospital bills contain mistakes such as unbundled codes or charges for services not rendered.