CMS Price Transparency Data

Blood test, complete blood count (CBC)

Facility: Fort Memorial Hospital

Billing Code: 85025 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85025
Insurance Median: $47
Cash Discount Price: $43
vs. Medicare Baseline: 6.05x Medicare

The contracted insurance negotiated median rate for a Blood test, complete blood count (CBC) at Fort Memorial Hospital is $47. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $43. Compared to the federal Medicare reimbursement reference rate of $7.77, this hospital’s rate is 6.05x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$43

Average discount available for prompt cash payment at this facility.

Insurance Median

$47

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$7.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $7.77 (100%)

Cash / Self-Pay: $43 (553%)

Insurance Median: $47 (605%)

Cash: $43 (553% of Medicare)

Ins. Median: $47 (605% of 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 605% of the Medicare baseline (a markup of 505%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$2 - $10	26%
Dean Health Plan	$2 - $69	26%
Managed Health Services	$2	26%
Medicaid / KanCare	$2	26%
Quartz	$2 - $44	26%
UnitedHealthcare	$2 - $13	26%
Molina	$6	77%
Humana	$8	103%
Centivo	$9 - $10	116%
Veteran Evaluation Services	$10	129%
Aetna	$50 - $105	644%
Group Health Cooperative	$80 - $250	1030%
Alliance	$89 - $100	1145%
Mercycare	$92 - $104	1184%
Trilogy	$109 - $123	1403%
Cigna	$118 - $133	1519%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $43.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 85025.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Fort Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 85025.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.