CMS Price Transparency Data

Blood test, complete blood count (CBC)

Facility: Fairview Hospital

Billing Code: 85025 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85025
Insurance Median: $48
Cash Discount Price: $71
vs. Medicare Baseline: 6.18x Medicare

The contracted insurance negotiated median rate for a Blood test, complete blood count (CBC) at Fairview Hospital is $48. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $71. Compared to the federal Medicare reimbursement reference rate of $7.77, this hospital’s rate is 6.18x the Medicare baseline. Located in 29 Lewis Avenue, Great Barrington, MA.

Cash / Self-Pay

$71

Average discount available for prompt cash payment at this facility.

Insurance Median

$48

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: $71 (914%)

Insurance Median: $48 (618%)

Cash: $71 (914% of Medicare)

Ins. Median: $48 (618% 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 618% of the Medicare baseline (a markup of 518%). 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
Capital District Physicians' Health Plan	$3 - $67	39%
Medicaid / KanCare	$3 - $7	39%
Aetna	$7 - $57	90%
Bmchnp	$7 - $8	90%
Health New England	$7 - $52	90%
Fallon	$8 - $33	103%
Hospice	$8 - $29	103%
Medicare (plans)	$8 - $29	103%
Other Government	$8 - $29	103%
Point32Health	$8 - $71	103%
UnitedHealthcare	$8 - $64	103%
Blue Cross Blue Shield	$9 - $64	116%
Commcare Alliance	$9 - $29	116%
Comm Fallon Qhp	$12 - $46	154%
Unicare	$20 - $49	257%
Allways Nhp	$48	618%
Workers Comp	$48	618%
Comm Hne Hmo	$49 - $56	631%
Comm Hne Ppo	$52 - $56	669%
Cigna	$67 - $70	862%
Mvp	$67	862%
Oxford	$67	862%
First Health	$70 - $71	901%
Connecticare	$71	914%
Consolidated Health Plans	$71	914%
Other Commercial	$71	914%
Phcs	$71	914%
Self Pay	$71	914%

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 $71.
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 Fairview 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.