Blood test, complete blood count (CBC)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $42
- Cash Discount Price: $38
- vs. Medicare Baseline: 5.41x 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 541% of the Medicare baseline (a markup of 441%). 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 | $42 - $47 | 541% |
| Providers Care (Wppa)-All Plans | $82 | 1055% |
Consumer Guidance & Cost Commentary
For a complete blood count (CBC) at the Hospital District #6 Patterson Health Center in Anthony, KS, the facility's cash median rate of $38.00 is notably lower than the state average, which sits at $47.00. While the facility's negotiated rates with major payers like UnitedHealthcare range from $42.00 to $47.00, these amounts are still higher than the cash price. This pricing structure suggests that patients with high-deductible plans or those without insurance might save money by paying the cash rate directly, as the insurance negotiated rates exceed the self-pay amount. It is important to note that the facility, a Critical Access Hospital owned by the government, offers a cash median of $38.00, which serves as a baseline for self-pay patients.
When comparing this service to Medicare, the facility's cash rate of $38.00 is significantly higher than the Medicare benchmark of $7.77, reflecting a markup of 5.4 times the federal rate. This disparity highlights how commercial pricing can differ substantially from the government's cost-based reimbursement. To minimize costs, patients should actively request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill. Furthermore, if a patient receives a bill that includes charges from out-of-network providers, such as certain lab services, they should verify the legality of any balance billing under the No Surprises Act and demand a full itemized audit to identify errors or unbundled codes before making a payment.