Blood test, complete blood count (CBC)
Facility: Girard Medical Center
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $39
- Cash Discount Price: $66
- vs. Medicare Baseline: 5.02x 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 502% of the Medicare baseline (a markup of 402%). 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 | $13 - $38 | 167% |
| Ambetter / Centene | $38 | 489% |
| Medicare (plans) | $38 | 489% |
| Humana | $38 | 489% |
| Aetna | $38 - $192 | 489% |
| Kansas Superior Select-All Plans | $38 | 489% |
| UnitedHealthcare | $38 - $104 | 489% |
| Multiplan-All Plans | $102 | 1313% |
| Uhhis-All Plans | $104 | 1338% |
Consumer Guidance & Cost Commentary
For a complete blood count (CBC) at Girard Medical Center in Girard, KS, the cash median price is $66.00, which is notably lower than the facility's negotiated rates of $39.00 to $192.00 depending on the insurance plan. While commercial payers like Aetna and UnitedHealthcare have negotiated ranges extending up to $192.00, patients with high-deductible plans may find paying the cash price directly more cost-effective, as the cash rate avoids the administrative markup and potential out-of-pocket maximums associated with insurance claims. It is important to note that while the facility is a Critical Access Hospital owned by a Government Hospital District, the cash rate does not automatically apply to insured patients; however, asking for a "self-pay" or "prompt-pay" discount before scheduling can sometimes result in a fee reduction that bridges the gap between the cash median and the negotiated amount.
The facility's pricing structure is evaluated against federal benchmarks, where the Medicare amount of $7.77 serves as the baseline for cost transparency. Although the data does not provide specific state or county average comparisons for this specific code, the significant difference between the Medicare rate and the cash price highlights the potential for substantial savings when paying directly. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but it is crucial to verify network status and request an itemized bill to ensure no unexpected charges for ancillary services occur. If a patient receives a bill exceeding the negotiated or cash rates, they should dispute the amount in writing to request a review of the charges against the facility's published rates