CMS Price Transparency Data

Blood test, complete blood count (CBC)

Facility: Adena Pike Medical Center

Billing Code: 85025 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85025
Insurance Median: $32
Cash Discount Price: $21
vs. Medicare Baseline: 4.12x Medicare

The contracted insurance negotiated median rate for a Blood test, complete blood count (CBC) at Adena Pike Medical Center is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21. Compared to the federal Medicare reimbursement reference rate of $7.77, this hospital’s rate is 4.12x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$21

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

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: $21 (270%)

Insurance Median: $32 (412%)

Cash: $21 (270% of Medicare)

Ins. Median: $32 (412% 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 412% of the Medicare baseline (a markup of 312%). 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
Aetna	$10 - $56	129%
Blue Cross Blue Shield	$10 - $37	129%
Buckeye Community Health Plan	$10	129%
Care Source	$10	129%
Humana	$10 - $40	129%
Medical Mutual Of Ohio	$10 - $27	129%
Medigold	$10	129%
Molina	$10	129%
Gateway Health	$14	180%
Molina Marketplace	$17	219%
Care Source Just4Me	$18	232%
Sidecar Health	$28	360%
Ohio Ppo Connect	$30	386%
The Health Plan	$30	386%
Cigna	$31	399%
Medical Mutual Of Ohio Supermed	$32	412%
First Health	$33 - $56	425%
Ohio Health Choice	$34	438%
Healthsmart	$40	515%
Integrated Health Plan	$40	515%
Multiplan/Private Healthcare Systems	$40	515%
Three Rivers Network	$40	515%
UnitedHealthcare	$80	1030%

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 $21.
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 Adena Pike Medical 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.