Blood test, complete blood count (CBC)
Facility: Hamilton County Hospital
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $46
- Cash Discount Price: $51
- vs. Medicare Baseline: 5.92x 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 592% of the Medicare baseline (a markup of 492%). 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 | $6 - $13 | 77% |
| First Health Coventry - All Plans | $43 | 553% |
| UnitedHealthcare | $48 | 618% |
| Cigna | $48 | 618% |
| Va Ccn - All Plans | $51 | 656% |
| Aetna | $87 | 1120% |
Consumer Guidance & Cost Commentary
For this complete blood count (CBC) test at Hamilton County Hospital in Syracuse, KS, the cash price is $51.00, which matches the facility's negotiated rate with UnitedHealthcare, Cigna, and the VA. This cash price is significantly lower than the state average for this procedure, making it an attractive option for patients with high-deductible plans or those without insurance. While the facility's negotiated rates with major payers like Blue Cross Blue Shield range from $43 to $51, and First Health Coventry is set at $43, these amounts are still higher than the cash price. Patients should verify their specific plan's deductible status before scheduling, as paying the cash price upfront may result in immediate savings compared to the insurance negotiated rate, provided the patient's out-of-pocket costs do not exceed the difference.
It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, unexpected ancillary charges can still occur if specific lab components are billed separately. To ensure you receive the most accurate pricing, always request a full itemized bill before paying, as summary invoices may obscure individual code costs. Additionally, ask the billing department about "self-pay" or "prompt-pay" discounts, which can further reduce the $51.00 cash price. Since this facility is a Critical Access Hospital with government ownership, their pricing structure is often more transparent than private networks, but confirming the exact classification of your visit as "self-pay" at registration is the most effective way to secure the lowest possible rate.