CMS Price Transparency Data

Blood test, complete blood count (CBC)

Facility: Mercy Hospital Carthage

Billing Code: 85025 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85025
Insurance Median: $61
Cash Discount Price: $73
vs. Medicare Baseline: 7.85x Medicare

The contracted insurance negotiated median rate for a Blood test, complete blood count (CBC) at Mercy Hospital Carthage is $61. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $73. Compared to the federal Medicare reimbursement reference rate of $7.77, this hospital’s rate is 7.85x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.

Cash / Self-Pay

$73

Average discount available for prompt cash payment at this facility.

Insurance Median

$61

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$7.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $7.77 (100%)

Cash / Self-Pay: $73 (940%)

Insurance Median: $61 (785%)

Cash: $73 (940% of Medicare)

Ins. Median: $61 (785% of 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 785% of the Medicare baseline (a markup of 685%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$7 - $100	90%
Blue Cross Blue Shield	$7 - $31	90%
Humana	$7 - $34	90%
Medicaid / KanCare	$7 - $61	90%
Medicare (plans)	$8 - $33	103%
United Medical Resources Contracted [320454]	$11 - $101	142%
UnitedHealthcare	$11 - $97	142%
Cherokee Nation Health Serv Contracted [320066]	$31	399%
Cigna	$31 - $101	399%
Cross Timbers Hospice [20098]	$31	399%
Dept Of Veteran Affairs Contracted [320106]	$31	399%
Elara Caring Aspire Hospice [20433]	$31	399%
Globalhealth Contracted [320145]	$31	399%
Halo Hcr Inc Hospice Contracted [320432]	$31	399%
Halo Hcr Inc Hospice [20432]	$31	399%
Indian Health Service Contracted [320198]	$31	399%
Kindful Hospice Contracted [320434]	$31	399%
Kindful Hospice [20434]	$31	399%
Medical Associates Health Contracted [320444]	$31	399%
Mercy Hospice Okc [20252]	$31	399%
Mercy Mgd Behavioral Health Contracted [320259]	$31	399%
Pace Of The Ozarks Contracted [320518]	$31	399%
Provider Partners Health Plans Contracted [320450]	$31	399%
Qual Choice Contracted [320325]	$31	399%
Tricare	$31	399%
Point C Contracted [320238]	$39 - $101	502%
Health Systems Inc Contracted [320174]	$48	618%
Insurance System Inc Contracted [320465]	$48	618%
Administrative Payor Contracted [320005]	$50	644%
Centivo Contracted [320505]	$52	669%
Healthscope Contracted [320182]	$58	746%
Ambetter / Centene	$61	785%
Home State Health Plan Contracted [320187]	$61	785%
Novasys Contracted [320285]	$61	785%
Benefit Management Contracted [320052]	$67 - $97	862%
Auxiant Contracted [320462]	$73 - $95	940%
Healthlink Contracted [320179]	$73 - $104	940%
Preferred Health Plan Contracted [320522]	$73	940%
Workers Comp [20426]	$90 - $112	1158%
90 Degree Benefits Contracted [320436]	$95	1223%
Aither Health Contracted [320449]	$95	1223%
Ebms Contracted [320493]	$95	1223%
Edison Health Solutions Contracted [320502]	$95	1223%
Imagine 360 Contracted [320494]	$95	1223%
Mercy Benefit Admin Contracted [320251]	$95 - $101	1223%
Reflect Health Contracted [320492]	$95	1223%
Show-Me Health Administrators Contracted [320483]	$95	1223%
Yuzu Health Contracted [320521]	$95	1223%
Evolutions Health Care Contracted [320124]	$97	1248%
First Health Contracted [320128]	$97	1248%
Medica Contracted [320239]	$97	1248%
Multiplan Contracted [320270]	$97	1248%
Private Health Care Systems Contracted [320320]	$97	1248%
American Healthcare Alliance Contracted [320020]	$101	1300%
Ppo Plus Contracted [320310]	$101	1300%
Usa Managed Care Org Contracted [320429]	$101	1300%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $73.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 85025.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mercy Hospital Carthage is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 85025.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.