CMS Price Transparency Data

Blood test, complete blood count (CBC)

Facility: UPMC Northwest

Billing Code: 85025 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85025
Insurance Median: $60
Cash Discount Price: $89
vs. Medicare Baseline: 7.72x Medicare

The contracted insurance negotiated median rate for a Blood test, complete blood count (CBC) at UPMC Northwest is $60. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $89. Compared to the federal Medicare reimbursement reference rate of $7.77, this hospital’s rate is 7.72x the Medicare baseline. Located in 100 Fairfield Drive, Seneca, PA.

Cash / Self-Pay

$89

Average discount available for prompt cash payment at this facility.

Insurance Median

$60

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: $89 (1145%)

Insurance Median: $60 (772%)

Cash: $89 (1145% of Medicare)

Ins. Median: $60 (772% 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 772% of the Medicare baseline (a markup of 672%). 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	$7 - $97	90%
UnitedHealthcare	$7 - $9	90%
Upmc Health Plan	$7 - $14	90%
Amerihealth Caritas	$8 - $9	103%
Blue Cross Blue Shield	$8 - $48	103%
Geisinger	$8	103%
Highmark Wholecare (Prev Gateway)	$8 - $9	103%
Pa Health & Wellness	$8 - $10	103%
Upmc Work Partners	$8	103%
Cigna	$60 - $97	772%
Intergroup	$97 - $3,704	1248%
Coventry/First Health	$104	1338%
Health Coalition Partners	$107	1377%
Private Health Care Systems	$119	1532%
Humana	$127	1634%

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 $89.
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 Northwest 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.