Blood test, complete blood count (CBC)
Facility: Stevens County Hospital
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $21
- Cash Discount Price: $55
- vs. Medicare Baseline: 2.70x 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 270% of the Medicare baseline (a markup of 170%). 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 |
|---|---|---|
| Aetna | $4 - $55 | 51% |
| Blue Cross Blue Shield | $13 | 167% |
| Humana | $20 | 257% |
| First Health - All Plans | $50 | 644% |
| Wppa - All Plans | $52 | 669% |
| Medicaid / KanCare | $55 | 708% |
Consumer Guidance & Cost Commentary
For this complete blood count (CBC) test at Stevens County Hospital in Hugoton, Kansas, the facility's cash price is $55.00, which matches the highest negotiated rate among the six insurance payers listed. While commercial plans like Aetna and Blue Cross Blue Shield negotiate rates as low as $4.00 to $13.00, these figures represent the maximum amounts insurers will pay toward your deductible, not the final amount you owe. If you have a high-deductible plan, paying the full cash price of $55.00 upfront may be more cost-effective than relying on insurance, as the negotiated allowed amount could exceed your out-of-pocket maximum or leave you with a large balance bill. Patients should explicitly ask the hospital for "self-pay" or "prompt-pay" discounts before scheduling, as paying in full within 30 days can often reduce the bill by 20% to 50% by bypassing administrative claim processing fees.
The facility's cash rate of $55.00 is significantly higher than the state and county averages for this service, which are reflected in the Medicare benchmark of $7.77 and the median negotiated rate of $21.00. This disparity highlights that commercial insurance contracts often include administrative markups that can inflate the final cost for patients. To ensure you are receiving fair pricing, it is advisable to request an itemized billing audit to verify that no unbundled codes or services not rendered are included in the charge. Additionally, since this facility is a Critical Access Hospital owned by the local government, you may be eligible for specific financial assistance programs or reduced rates that are not automatically applied to insurance claims. Always confirm