Blood test, complete blood count (CBC)
Facility: Children'S Mercy South
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $59
- Cash Discount Price: $44
- vs. Medicare Baseline: 7.59x 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 759% of the Medicare baseline (a markup of 659%). 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 |
|---|---|---|
| UnitedHealthcare | $7 - $61 | 90% |
| Healthy Blue | $7 - $21 | 90% |
| Medicaid / KanCare | $8 | 103% |
| Home State Health | $19 | 245% |
| Blue Cross Blue Shield | $37 - $67 | 476% |
| Cigna | $44 - $63 | 566% |
| Medica | $53 | 682% |
| Aetna | $55 - $62 | 708% |
| Wellfit/Centrus | $59 | 759% |
| Quiktrip | $59 | 759% |
| Health Midwest Comprehensive Care | $59 | 759% |
| Nebraska Furniture Mart | $59 | 759% |
| Wppa Providrs Care | $59 | 759% |
| Centivo | $59 | 759% |
| Orscheln | $59 | 759% |
| Humana | $61 | 785% |
| Coxhealth Network | $67 | 862% |
| Coventry Health Care Of Kansas | $67 | 862% |
| Mercy Health | $68 | 875% |
| Multiplan | $69 | 888% |
| American Healthcare Alliance | $77 | 991% |
| Healthlink | $80 | 1030% |
| National Preferred Provider Network | $82 | 1055% |
Consumer Guidance & Cost Commentary
For the CPT code 85025, a complete blood count (CBC) at Children's Mercy South in Overland Park, Kansas, the facility's cash median price is $44.00. This cash rate is significantly lower than the facility's negotiated rates, which range from $59.00 to $82.00 depending on the insurance carrier. While the facility's negotiated rates are higher than the cash price, patients with high-deductible plans may find the cash option more cost-effective if their insurance allowed amount exceeds $44.00. It is important to note that commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the baseline price compared to direct cash payments.
The facility's cash price of $44.00 is notably lower than the state average for this procedure, which is $7.60 higher than the cash rate. Additionally, the cash price is well below the Medicare benchmark of $7.77, indicating that the facility's self-pay pricing is competitive relative to federal reimbursement standards. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, it does not apply to self-pay scenarios. To ensure the lowest possible cost, patients are encouraged to contact the hospital directly to confirm "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed before any insurance claims are processed.