CMS Price Transparency Data

Blood test, complete blood count (CBC)

Facility: South Miami Hospital

Billing Code: 85025 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85025
Insurance Median: $130
Cash Discount Price: $197
vs. Medicare Baseline: 16.73x Medicare

The contracted insurance negotiated median rate for a Blood test, complete blood count (CBC) at South Miami Hospital is $130. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $197. Compared to the federal Medicare reimbursement reference rate of $7.77, this hospital’s rate is 16.73x the Medicare baseline. Located in 6200 Sw 73Rd St, Miami, FL.

Cash / Self-Pay

$197

Average discount available for prompt cash payment at this facility.

Insurance Median

$130

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: $197 (2535%)

Insurance Median: $130 (1673%)

Cash: $197 (2535% of Medicare)

Ins. Median: $130 (1673% 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 1673% of the Medicare baseline (a markup of 1573%). 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
Aetna	$3 - $311	39%
Amerigroup	$3	39%
Medicaid / KanCare	$3	39%
Sunshine State	$3	39%
UnitedHealthcare	$3 - $389	39%
Vista	$3	39%
Wellcare	$3	39%
Blue Cross Blue Shield	$8 - $252	103%
Humana	$8	103%
Medica Health Plan	$8	103%
Medicare (plans)	$8 - $10	103%
Avmed	$9 - $193	116%
Cigna	$9 - $311	116%
Leon Medical	$9	116%
Non Contracted	$80 - $143	1030%
Amerihealth	$98 - $175	1261%
International	$141 - $253	1815%
Dimension Health Plan	$163 - $350	2098%
Affordable	$184 - $331	2368%
Phcs	$195 - $350	2510%
Quality Health	$195 - $350	2510%

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 $197.
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 South Miami 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.