Blood test, complete blood count (CBC)
Facility: Hiawatha Community Hospital
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $37
- Cash Discount Price: $47
- vs. Medicare Baseline: 4.76x 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 476% of the Medicare baseline (a markup of 376%). 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% |
| UnitedHealthcare | $17 - $40 | 219% |
| Aetna | $17 - $38 | 219% |
| Humana | $18 | 232% |
| Ambetter / Centene | $21 | 270% |
| Centrus Health Direct - All Plans | $35 | 450% |
| Oscar - All Plans | $35 | 450% |
| Preferred Hlth - All Plans | $42 | 541% |
| Cigna | $45 | 579% |
| Wppa Providrs Care - All Plans | $45 | 579% |
| Multiplan - All Plans | $46 | 592% |
| Midlands Choice - All Plans | $46 | 592% |
| Healthy Blue Mcaid - All Plans | $47 | 605% |
Consumer Guidance & Cost Commentary
For the complete blood count (CBC) test at Hiawatha Community Hospital, the cash price is $47.00, which matches the facility's negotiated median paid amount of $21.00. This cash rate is significantly higher than the Medicare benchmark of $7.77, reflecting the standard markup found in commercial billing where negotiated rates often average 200% to 300% of the federal baseline. While the facility is a Critical Access Hospital in Hiawatha, KS, with a voluntary non-profit ownership structure, patients should be aware that commercial negotiated rates can sometimes exceed cash prices due to administrative overhead and contract dynamics. If you have a high-deductible plan, paying the cash price of $47.00 upfront might be more cost-effective than relying on insurance, especially if your deductible has not yet been met or if the insurer's allowed amount is lower than the cash rate.
To ensure you are receiving the best possible price, it is essential to verify your specific insurance plan's negotiated rate before scheduling, as these vary widely among the 13 payers listed for this service. For instance, while UnitedHealthcare and Aetna have negotiated ranges starting at $17, other carriers like Cigna and Multiplan have rates at $45 and $46, respectively. Patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid in full within a short window, bypassing costly claims processing fees. Additionally, if you receive a bill, always request a detailed, itemized statement to audit for errors such as double-billing or unbundled