CMS Price Transparency Data

Blood test, complete blood count (CBC)

Facility: Little Falls Hospital

Billing Code: 85025 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85025
Insurance Median: $8
Cash Discount Price: $41
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Blood test, complete blood count (CBC) at Little Falls Hospital is $8. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41. Compared to the federal Medicare reimbursement reference rate of $7.77, this hospital’s rate is 1.03x the Medicare baseline. Located in 140 Burwell Street, Little Falls, NY.

Cash / Self-Pay

$41

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: $41 (528%)

Insurance Median: $8 (103%)

Cash: $41 (528% of Medicare)

Ins. Median: $8 (103% 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
Blue Cross Blue Shield	$3 - $143	39%
Cdphp	$3 - $44	39%
Emblem	$3 - $43	39%
Mvp	$3 - $44	39%
UnitedHealthcare	$3 - $43	39%
Fidelis	$4 - $46	51%
Aetna	$8 - $46	103%
Humana	$8 - $46	103%
Cigna	$131	1686%

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 $41.
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 Little Falls 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.