Blood test, complete blood count (CBC)
Facility: Memorial Hospital
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $27
- Cash Discount Price: $37
- vs. Medicare Baseline: 3.47x 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 347% of the Medicare baseline (a markup of 247%). 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 | $9 | 116% |
| Humana | $10 - $27 | 129% |
| Tricare | $10 - $27 | 129% |
| Medicare (plans) | $10 - $27 | 129% |
| Ambetter / Centene | $11 - $30 | 142% |
| Coventry - All Other Plans | $18 - $49 | 232% |
| Health Partners Of Kansas - All Plans | $19 - $51 | 245% |
| Preferred Healthcare-All Plans | $19 - $51 | 245% |
| Wppa/Providers Care-All Plans | $28 - $76 | 360% |
Consumer Guidance & Cost Commentary
For a complete blood count (CBC) at Memorial Hospital in Abilene, KS, the cash price is $37.00, which matches the facility's median negotiated rate of $27.00 and the state average. While many commercial payers negotiate rates ranging from $9 to $76 depending on their specific plan, the cash price remains the lowest option available. Patients with high-deductible plans may find it financially advantageous to pay the $37.00 cash price directly, as this avoids the administrative overhead and potential higher negotiated rates that insurance companies charge. To secure this lower amount, patients should explicitly request a "self-pay" classification and ask about prompt-pay discounts before scheduling, ensuring the billing system does not automatically submit a claim that would void the cash agreement.
The facility's pricing is significantly lower than the Medicare benchmark of $7.77 for this procedure, indicating a substantial markup relative to the federal government's cost-based reimbursement. Although the facility is a Critical Access Hospital owned by a government hospital district, the negotiated rates for in-network plans vary widely, with some plans paying as high as $76.00. Because the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should verify their specific plan's allowed amount before receiving care. If a patient receives a bill exceeding the cash price, they should request an itemized audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected to reduce debt.