CMS Price Transparency Data

Blood test, complete blood count (CBC)

Facility: Hospital for Special Surgery

Billing Code: 85025 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85025
Insurance Median: $90
Cash Discount Price: $175
vs. Medicare Baseline: 11.58x Medicare

The contracted insurance negotiated median rate for a Blood test, complete blood count (CBC) at Hospital for Special Surgery is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $175. Compared to the federal Medicare reimbursement reference rate of $7.77, this hospital’s rate is 11.58x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$175

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $175 (2252%)

Insurance Median: $90 (1158%)

Cash: $175 (2252% of Medicare)

Ins. Median: $90 (1158% 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 1158% of the Medicare baseline (a markup of 1058%). 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	$3 - $191	39%
UnitedHealthcare	$4 - $155	51%
Fidelis Essential [1323]	$7	90%
Aetna	$88 - $90	1133%
Christian Brothers [1034]	$88 - $90	1133%
Meritain Health [1085]	$88 - $90	1133%
Nippon Life [1092]	$88 - $90	1133%
Webtpa [1356]	$88 - $90	1133%
Affinity By Molina Health Plan [1005]	$90 - $122	1158%
Connecticare [1039]	$90 - $119	1158%
Emblem Health [1043]	$90 - $119	1158%
Harvard Pilgrim [1057]	$90 - $155	1158%
Medicare (plans)	$90	1158%
Oxford [1096]	$90 - $105	1158%
Student Resources [1103]	$90 - $128	1158%
Geha [1053]	$128	1647%
Apwu [1016]	$129 - $144	1660%
Cigna	$129 - $144	1660%
Nalc [1090]	$129 - $144	1660%
Qualcare [1101]	$129 - $144	1660%
Wellfleet [1361]	$129 - $144	1660%

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 $175.
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 Hospital for Special Surgery 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.