Blood test, complete blood count (CBC)
Facility: Phillips County Hospital
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $34
- Cash Discount Price: $32
- vs. Medicare Baseline: 4.38x 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 438% of the Medicare baseline (a markup of 338%). 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 - $31 | 167% |
| UnitedHealthcare | $30 - $38 | 386% |
| Medicaid / KanCare | $38 | 489% |
| Health Partners-All Plans | $38 | 489% |
Consumer Guidance & Cost Commentary
For a complete blood count (CBC) at Phillips County Hospital in Phillipsburg, KS, the facility's cash price of $32.00 is notably lower than the state average of $38.00, making it a cost-effective option for self-pay patients. While the hospital's negotiated rates with major payers like Blue Cross Blue Shield and UnitedHealthcare range from $13.00 to $38.00, these amounts often exceed the cash price, which can be advantageous for patients with high-deductible plans who may not yet have met their coverage thresholds. Because the facility is a Critical Access Hospital owned by the local government, patients should proactively ask about "self-pay" or "prompt-pay" discounts before scheduling, as paying the bill in full upfront can sometimes bypass administrative fees and result in a lower final charge than the standard insurance allowed amount.
The facility's billing structure aligns closely with federal benchmarks, with the Medicare rate for this procedure set at $7.77 and the facility's cash price at $32.00, which is approximately 4.4 times the Medicare amount. This markup is typical for commercial services but highlights the importance of verifying your specific plan's allowed amount, as some insurance negotiations may yield rates closer to the cash price. To ensure you are not overcharged, request a detailed, itemized bill that breaks down every CPT code and charge, as summary bills often obscure individual line items. If you receive a balance bill for services not covered by your plan, remember that the No Surprises Act protects you from unexpected out-of-network charges for emergency care and non-emergency services at in-network facilities, so do not sign away your rights to