CMS Price Transparency Data

Blood test, complete blood count (CBC)

Facility: Elmhurst Hospital Center

Billing Code: 85025 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85025
Insurance Median: $31
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.99x Medicare

The contracted insurance negotiated median rate for a Blood test, complete blood count (CBC) at Elmhurst Hospital Center is $31. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $7.77, this hospital’s rate is 3.99x the Medicare baseline. Located in 79-01 Broadway, Elmhurst, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$31

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%)

Insurance Median: $31 (399%)

Ins. Median: $31 (399% 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 399% of the Medicare baseline (a markup of 299%). 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
Healthfirst	$3 - $69	39%
Aetna	$6 - $23	77%
Elderplan	$8	103%
Fidelis	$8 - $69	103%
Magnacare	$9	116%
Oxford	$11	142%
United	$11 - $38	142%
Oscar	$12	154%
Centerlight	$16	206%
Cigna	$19	245%
Wellcare	$20	257%
Carelon	$21 - $31	270%
Emblem	$23 - $41	296%
Blue Cross Blue Shield	$25 - $69	322%
Multiplan	$26	335%
Local 1199	$28	360%
Villagecare Max	$28	360%
Vnsny	$28 - $31	360%
Metroplus	$29 - $69	373%
Affinity	$31 - $69	399%
Amidacare	$31	399%
Carelon (Amida Care)	$31	399%
Senior Whole Health	$31	399%
United Behavioral Health	$31 - $34	399%

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 $X.
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 Elmhurst Hospital Center 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.