CMS Price Transparency Data

Blood test, complete blood count (CBC)

Facility: Hamilton Memorial Hospital

Billing Code: 85025 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85025
Insurance Median: $78
Cash Discount Price: $83
vs. Medicare Baseline: 10.04x Medicare

The contracted insurance negotiated median rate for a Blood test, complete blood count (CBC) at Hamilton Memorial Hospital is $78. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $83. Compared to the federal Medicare reimbursement reference rate of $7.77, this hospital’s rate is 10.04x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$83

Average discount available for prompt cash payment at this facility.

Insurance Median

$78

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: $83 (1068%)

Insurance Median: $78 (1004%)

Cash: $83 (1068% of Medicare)

Ins. Median: $78 (1004% 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 1004% of the Medicare baseline (a markup of 904%). 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
Medicaid / KanCare	$36 - $39	463%
Blue Cross Blue Shield	$37 - $89	476%
Aetna	$39 - $88	502%
Health Alliance	$39 - $78	502%
Humana	$39	502%
Medicare (plans)	$39	502%
UnitedHealthcare	$39 - $70	502%
Wellcare	$39	502%
Alliance Coal	$68	875%
Healthscope	$68	875%
Wellfirst (Ssmhic)	$68	875%
Hope Trust	$73	940%
Cigna	$77	991%
Hfn, Inc	$78 - $88	1004%
Healthlink	$83 - $88	1068%
Multiplan	$83	1068%
Siho	$88	1133%
Three Rivers Provider	$88	1133%
Healthsmart	$93	1197%
Stratose	$93	1197%

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 $83.
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 Hamilton Memorial Hospital 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.