Blood test, complete blood count (CBC)
Facility: Regional Medical Center
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $870
- Cash Discount Price: $88
- vs. Medicare Baseline: 111.97x 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 11197% of the Medicare baseline (a markup of 11097%). 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 |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 11197% |
Consumer Guidance & Cost Commentary
A self-pay patient should know that paying cash directly for this blood test can be the most cost-effective option, as the facility's cash rate of $88 is significantly lower than the negotiated rate of $870 charged by Medical Associates Health Plan - Tri. While insurance contracts often set a maximum payment ceiling, patients with high-deductible plans or those who have not yet met their deductible may find that paying the cash price upfront avoids the substantial administrative markup embedded in the insurance negotiated rate. It is highly recommended to ask the hospital to classify the visit as "self-pay" or "prompt-pay" before check-in to ensure you receive the lowest possible fee and to prevent the facility from automatically submitting a claim that could void any cash discount.
The broader pricing context reveals that the facility's cash rate of $88 is very close to its median paid rate of $41, suggesting that commercial insurance payments for this service are often lower than the cash price due to the administrative costs of claims processing. Although the facility's gross charge is $110, the median negotiated rate of $870 represents a significant markup compared to the cash option, highlighting that in-network coverage does not always guarantee the lowest price. Patients should be aware that Medicare rates ($7.77) serve as a baseline for true cost, and while the facility is a Critical Access Hospital in Manchester, IA, with a government-local ownership structure, the most transparent approach for patients is to compare the cash rate directly against their specific insurance allowed amount rather than relying on summary bills or assuming in-network status equals the best price.