CMS Price Transparency Data

Blood test, complete blood count (CBC)

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 85025 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85025
Insurance Median: $134
Cash Discount Price: $172
vs. Medicare Baseline: 17.25x Medicare

The contracted insurance negotiated median rate for a Blood test, complete blood count (CBC) at UPMC Children's Hospital of Pittsburgh is $134. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $172. Compared to the federal Medicare reimbursement reference rate of $7.77, this hospital’s rate is 17.25x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$172

Average discount available for prompt cash payment at this facility.

Insurance Median

$134

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: $172 (2214%)

Insurance Median: $134 (1725%)

Cash: $172 (2214% of Medicare)

Ins. Median: $134 (1725% 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 1725% of the Medicare baseline (a markup of 1625%). 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 - $157	90%
Amerihealth Caritas	$8 - $22	103%
Blue Cross Blue Shield	$8 - $64	103%
Cigna	$8 - $157	103%
Health Plan Of Upper Ohio Valley	$8 - $186	103%
Upmc Health Plan	$14 - $61	180%
Health Partners Plans (Jefferson Health Plan)	$23	296%
Highmark Wholecare (Prev Gateway)	$24	309%
Pa Health & Wellness	$24	309%
UnitedHealthcare	$24 - $134	309%
Geisinger	$25 - $129	322%
Intergroup	$186 - $243	2394%
Coventry/First Health	$229	2947%
Saudi Armed Forces	$229	2947%
Health Payors Organization	$243	3127%
Multiplan	$243	3127%
National Provider Network	$257	3308%
Private Health Care Systems	$257	3308%

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 $172.
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 Children's Hospital of Pittsburgh 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.