CMS Price Transparency Data

Blood test, complete blood count (CBC)

Facility: Highland Hospital

Billing Code: 85025 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85025
Insurance Median: $7
Cash Discount Price: $38
vs. Medicare Baseline: 0.90x Medicare

The contracted insurance negotiated median rate for a Blood test, complete blood count (CBC) at Highland Hospital is $7. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $38. Compared to the federal Medicare reimbursement reference rate of $7.77, this hospital’s rate is 0.90x the Medicare baseline. Located in 1000 South Avenue, Rochester, NY.

Cash / Self-Pay

$38

Average discount available for prompt cash payment at this facility.

Insurance Median

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: $38 (489%)

Insurance Median: $7 (90%)

Cash: $38 (489% of Medicare)

Ins. Median: $7 (90% 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.

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
Molina Healthcare [5189], Molina Healthcare [1723]	$4 - $7	51%
UnitedHealthcare	$4 - $9	51%
Medicaid / KanCare	$5 - $12	64%
Amerigroup (Bswny Alternate) [1720]	$7	90%
Cigna	$7	90%
Excellus [2201]	$7 - $9	90%
Fidelis [5155]	$7	90%
Medicare (plans)	$7 - $12	90%
Mvp [2900]	$7	90%
Martins Point [1205]	$8	103%
Aetna	$10 - $13	129%
Humana	$10	129%
Independent Health [5156]	$12	154%

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 $38.
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 Highland 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.