Blood test, complete blood count (CBC)
Facility: Nemaha Valley Community Hospital
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $9
- Cash Discount Price: $29
- vs. Medicare Baseline: 1.16x 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.
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 |
|---|---|---|
| Va Ccn - All Plans | $4 | 51% |
| Aetna | $4 - $48 | 51% |
| Humana | $4 - $25 | 51% |
| Celtic Comm Exch - All Plans | $4 - $27 | 51% |
| Partners Direct Health - All Plans | $5 - $29 | 64% |
| Multiplan - All Plans | $8 - $50 | 103% |
| Health Partners - All Plans | $9 - $53 | 116% |
| Midlands Choice - All Plans | $9 - $53 | 116% |
Consumer Guidance & Cost Commentary
For the complete blood count (CBC) test at Nemaha Valley Community Hospital in Seneca, Kansas, the facility's cash price of $29.00 is notably higher than the state average of $26.00. While the hospital is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. In this case, the median negotiated rate across payers is $9.00, which is significantly lower than the cash price, suggesting that for patients with high-deductible plans, paying out-of-pocket might not be the most cost-effective option unless the insurance allowed amount is also high. It is important to verify your specific plan's allowed amount before scheduling, as assuming in-network status guarantees the lowest price can lead to unexpected costs if the insurer's negotiated rate is higher than the cash price.
The facility's billing practices align with standard industry benchmarks, with a Medicare amount of $7.77 serving as the baseline for cost evaluation. The gross charge of $33.00 represents the full list price, while the median paid amount under insurance is $26.00. Patients should consider requesting a prompt-pay discount if they choose to pay directly, as hospitals often offer fee reductions of 20% to 50% for upfront payment to bypass costly claims processing and administrative delays. Additionally, if you receive an itemized bill, ensure it is fully detailed rather than a summary to avoid errors such as double-billing or unbundled codes, which are common in hospital billing. Always check your deductible status before using insurance, as paying with a card on file may trigger automatic claims submission