Blood test, complete blood count (CBC)
Facility: Holton Community Hospital
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $43
- Cash Discount Price: $47
- vs. Medicare Baseline: 5.53x 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 553% of the Medicare baseline (a markup of 453%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $13 | 167% |
| Kansas Superior Select - All Plans | $24 - $44 | 309% |
| Aetna | $24 - $81 | 309% |
| Humana | $24 - $43 | 309% |
| UnitedHealthcare | $24 - $81 | 309% |
| Preferred Health Professionals | $37 - $67 | 476% |
| Preferred Health Freedom | $37 - $67 | 476% |
| Preferred Health Fn Select - All Other Plans | $37 - $67 | 476% |
| Wppa Providers - All Plans | $42 - $77 | 541% |
| Medicaid / KanCare | $45 - $81 | 579% |
Consumer Guidance & Cost Commentary
For the complete blood count (CBC) test at Holton Community Hospital in Holton, Kansas, the facility's cash median price is $47.00, which is lower than the state average of $63.00. While many commercial payers negotiate rates ranging from $24 to $81, these amounts are often higher than the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the negotiated rates for in-network plans can exceed the out-of-pocket cost of paying cash. It is important to verify your specific plan's deductible status before scheduling, as paying the full negotiated rate may not be covered until that threshold is met.
To ensure you are not overcharged, always request a detailed itemized bill that lists specific CPT codes rather than accepting a summary invoice that obscures individual line items. If you receive a balance bill for the difference between the provider's full charge and your insurance allowed amount, you may be protected under the No Surprises Act, which bans such billing for emergency care and non-emergency services at in-network facilities. Additionally, ask the hospital about prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid in full upfront, effectively bypassing the administrative fees associated with insurance claims processing.