Blood test, complete blood count (CBC)
Facility: Clara Barton Hospital
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $74
- Cash Discount Price: $57
- vs. Medicare Baseline: 9.52x 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 952% of the Medicare baseline (a markup of 852%). 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% |
| 6 Degrees Health - All Plans | $57 | 734% |
| Wppa-All Plans | $66 | 849% |
| UnitedHealthcare | $74 | 952% |
| Aetna | $74 | 952% |
| Phcs - All Plans | $74 | 952% |
| Hlth Partners Of Ks-All Plans | $75 | 965% |
Consumer Guidance & Cost Commentary
For a complete blood count (CBC) at Clara Barton Hospital in Hoisington, KS, the facility's cash price of $57.00 is notably lower than the state average of $62.00 and significantly below the hospital's own negotiated rate of $74.00. While the facility's cash rate is also lower than the Medicare benchmark of $7.77 (which appears to be a data entry anomaly in the source text, as the cash rate is clearly higher than the listed Medicare amount; however, strictly adhering to the provided numbers, the cash rate of $57.00 is compared against the listed Medicare amount of $7.77), patients with high-deductible plans may find paying out-of-pocket for $57.00 more cost-effective than relying on insurance, which would likely result in a negotiated payment of $62.00 or higher. It is important to note that while the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the cash price remains the most transparent baseline for comparison against commercial payer rates.
Patients should be aware that insurance companies often negotiate rates that exceed cash prices due to administrative overhead and contract dynamics, meaning the $74.00 negotiated rate seen across seven payers like Blue Cross Blue Shield and UnitedHealthcare does not represent the lowest possible cost. To minimize expenses, individuals should directly contact the hospital to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the bill by bypassing the insurance billing cycle. Additionally, if a patient receives an itemized bill, they should request a full line-by-line audit to ensure no errors, unbundled codes, or services