Blood test, complete blood count (CBC)
Facility: Sheridan County Hospital
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $23
- Cash Discount Price: $38
- vs. Medicare Baseline: 2.96x 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 296% of the Medicare baseline (a markup of 196%). 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 | $18 | 232% |
| Celtic Insurance | $23 | 296% |
| UnitedHealthcare | $36 | 463% |
Consumer Guidance & Cost Commentary
For the complete blood count (CBC) test at Sheridan County Hospital in Hoxie, Kansas, the cash price is $38.00, which matches the facility's median negotiated rate for this service. This cash price is significantly lower than the Medicare benchmark of $7.77, indicating that the facility's standard billing structure for this procedure is well above the federal cost baseline. While the facility is a Critical Access Hospital owned by the local government, patients with high-deductible plans may find that paying the full cash price of $38.00 upfront is more cost-effective than relying on insurance, as commercial negotiated rates often exceed cash prices due to administrative overhead. It is important to note that while the data shows a median negotiated rate of $23.00, this figure represents the average amount paid by insurers across plans; individual patient out-of-pocket costs will vary based on their specific deductible status and plan coverage.
Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, though unexpected charges can still occur if ancillary services like lab tests are billed by out-of-network providers. If you receive a bill that appears to include balance billing, you should request an itemized audit to verify that all charges correspond to services actually rendered and that no unbundled codes or errors exist, as over 80% of hospital bills contain mistakes. Additionally, before scheduling any future visits, you should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if you pay in full upfront, bypassing the costly insurance claims processing cycle