Blood test, complete blood count (CBC)
Facility: Fredonia Regional Hospital
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $37
- Cash Discount Price: $41
- 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 |
|---|---|---|
| UnitedHealthcare | $3 - $37 | 39% |
| Blue Cross Blue Shield | $13 - $20 | 167% |
| Veterans Programs - All Plans | $21 | 270% |
| Aetna | $21 - $37 | 270% |
| Meritain-All Plans | $37 | 476% |
| Reserve National-All Plans | $37 | 476% |
| Cigna | $37 | 476% |
Consumer Guidance & Cost Commentary
For a complete blood count (CBC) at Fredonia Regional Hospital in Fredonia, KS, the cash price is $41.00, which matches the facility's median negotiated rate of $37.00 and the state average of $41.00. While the facility is a Critical Access Hospital owned by the local government, patients with high-deductible plans may find paying cash upfront more cost-effective than using insurance, as the commercial negotiated rates from payers like UnitedHealthcare and Aetna range from $13 to $37 depending on the specific plan. It is important to note that cash payments often bypass the administrative overhead of claims processing, potentially resulting in lower out-of-pocket costs compared to the full insurance allowed amount, which varies significantly across the seven payers represented here.
The Medicare benchmark for this service is $7.77, highlighting that the facility's cash price of $41.00 represents a significant markup over the federal baseline. To minimize costs, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as these upfront payment incentives can reduce the bill by 20% to 50%. Additionally, since the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients should verify that all ancillary services, such as lab draws, are covered under the facility's network agreements to avoid unexpected secondary charges. Always obtain a detailed, itemized bill before finalizing payment to ensure no unbundled codes or services not rendered are included in the total.