Blood test, complete blood count (CBC)
Facility: Morris County Hospital
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $45
- Cash Discount Price: $69
- vs. Medicare Baseline: 5.79x 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 579% of the Medicare baseline (a markup of 479%). 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 |
|---|---|---|
| Providrs Care (Wppa)(Nexus)-All Plans | $8 | 103% |
| Va Ccn-All Plans | $9 | 116% |
| Blue Cross Blue Shield | $13 - $45 | 167% |
| Aetna | $18 | 232% |
| UnitedHealthcare | $45 - $115 | 579% |
| Coventry Mcr | $45 | 579% |
| Choice Care Mcr Adv-All Plans | $45 | 579% |
| Cigna | $83 | 1068% |
| Multiplan-All Plans | $104 | 1338% |
| Coventry Comm-All Other Plans | $104 | 1338% |
Consumer Guidance & Cost Commentary
For this blood test at Morris County Hospital in Council Grove, Kansas, the facility's cash price of $69.00 is notably lower than the state average for this service. While the hospital's negotiated rates with insurance carriers range from $8 to $115 depending on the plan, the cash price offers a significant alternative for patients with high-deductible plans or those without coverage. It is important to note that insurance negotiated rates often exceed cash prices due to administrative costs and contract structures; therefore, paying out-of-pocket can sometimes result in lower out-of-pocket costs if your insurance allowed amount is higher than $69.00. Patients should verify their specific plan's allowed amount before scheduling, as some commercial payers may negotiate rates that are higher than the facility's self-pay rate.
The facility's cash price of $69.00 is also lower than the Medicare benchmark of $7.77, which serves as a scientifically validated baseline for healthcare costs. This comparison highlights that the facility's cash rate is substantially higher than the federal government's cost-based reimbursement, reflecting the local market dynamics and facility operating costs. For transparency, the facility's median negotiated rate is $45.00, which sits below the cash price but above the Medicare amount. To ensure you receive the best possible rate, we recommend contacting the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront payment incentives can further reduce the final bill. Always request an itemized bill before paying to ensure all charges are accurate and to avoid unexpected balance billing, which is largely prohibited for emergency and non-emergency services at in-network facilities under federal law.