Blood test, complete blood count (CBC)
Facility: Smith County Memorial Hospital
Billing Code: 85025 (CPT)
- CPT Billing Code: 85025
- Insurance Median: $38
- Cash Discount Price: $40
- vs. Medicare Baseline: 4.89x 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 489% of the Medicare baseline (a markup of 389%). 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% |
| Medicaid / KanCare | $28 - $40 | 360% |
| Multiplan-All Plans | $36 | 463% |
| Health Partners Of Ks Ppo-All Plans | $38 | 489% |
| Wppa-All Plans | $38 | 489% |
| UnitedHealthcare | $38 | 489% |
| Midlands Choice-All Plans | $38 | 489% |
Consumer Guidance & Cost Commentary
For a complete blood count (CBC) at Smith County Memorial Hospital in Smith Center, KS, the facility's cash price of $40.00 is identical to the state average, while the median negotiated rate across seven payers sits at $38.00. This test is billed under CPT code 85025, and the facility, a Critical Access Hospital owned by the local government, has a gross charge of $40.00. For patients with high-deductible plans, paying the cash price of $40.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash price due to administrative overhead and contract structures. It is advisable to confirm with the hospital whether "self-pay" or "prompt-pay" discounts are available before scheduling, as these can further reduce the final amount owed.
The facility's negotiated rates are significantly higher than the Medicare benchmark of $7.77, reflecting the standard markup for commercial insurance contracts. While the Medicare amount serves as a baseline for fair pricing, the actual cost to patients depends on their specific plan's deductible and out-of-pocket maximums. Patients should be aware that assuming an in-network rate is the lowest possible price is a common pitfall, as different insurers negotiate different ceilings for the same service. To ensure transparency, consumers should request an itemized bill listing specific CPT codes to verify that no unbundled charges or services not rendered have been included, and they should dispute any balance billing that exceeds the No Surprises Act protections for in-network emergency or non-emergency care.