CMS Price Transparency Data

Blood test, complete blood count (CBC)

Facility: UPMC Pinnacle Hospitals

Billing Code: 85025 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85025
Insurance Median: $44
Cash Discount Price: $42
vs. Medicare Baseline: 5.66x Medicare

The contracted insurance negotiated median rate for a Blood test, complete blood count (CBC) at UPMC Pinnacle Hospitals is $44. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42. Compared to the federal Medicare reimbursement reference rate of $7.77, this hospital’s rate is 5.66x the Medicare baseline. Located in 409 South Second Street, Harrisburg, PA.

Cash / Self-Pay

$42

Average discount available for prompt cash payment at this facility.

Insurance Median

$44

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: $42 (541%)

Insurance Median: $44 (566%)

Cash: $42 (541% of Medicare)

Ins. Median: $44 (566% 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 566% of the Medicare baseline (a markup of 466%). 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
Amerihealth Caritas	$6	77%
Aetna	$8 - $54	103%
Blue Cross Blue Shield	$8 - $60	103%
Cigna	$8	103%
Health Partners Plans (Jefferson Health Plan)	$8	103%
Humana	$8	103%
Pa Health & Wellness	$8 - $10	103%
UnitedHealthcare	$8	103%
Upmc Work Partners	$8	103%
Geisinger	$9	116%
Keystone Health Plan	$13 - $45	167%
Prime Net	$16 - $56	206%
Intergroup	$44 - $63	566%
Upmc Health Plan	$49	631%
Wellspan Population Health	$57 - $63	734%

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 $42.
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 UPMC Pinnacle Hospitals 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.