CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Fishermen's Community Hospital

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $40
Cash Discount Price: $54
vs. Medicare Baseline: 9.32x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Fishermen's Community Hospital is $40. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $54. Compared to the federal Medicare reimbursement reference rate of $4.29, this hospital’s rate is 9.32x the Medicare baseline. Located in 3301 Overseas Hwy, Marathon, FL.

Cash / Self-Pay

$54

Average discount available for prompt cash payment at this facility.

Insurance Median

$40

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$4.29

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $4.29 (100%)

Cash / Self-Pay: $54 (1259%)

Insurance Median: $40 (932%)

Cash: $54 (1259% of Medicare)

Ins. Median: $40 (932% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $4.29 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 932% of the Medicare baseline (a markup of 832%). 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	$2 - $154	47%
Amerigroup	$2	47%
Medicaid / KanCare	$2	47%
Sunshine State	$2	47%
UnitedHealthcare	$2 - $201	47%
Vista	$2	47%
Wellcare	$2	47%
Blue Cross Blue Shield	$4 - $201	93%
Leon Medical	$5 - $42	117%
Medica Health Plan	$5 - $42	117%
Medicare (plans)	$5 - $57	117%
Avmed	$6 - $166	140%
Cigna	$6 - $161	140%
Humana	$6 - $46	140%
Non Contracted	$9 - $74	210%
International	$16 - $131	373%
Amerihealth	$19 - $151	443%
Dimension Health Plan	$19 - $181	443%
Affordable	$22 - $181	513%
Phcs	$22 - $181	513%
Quality Health	$22 - $181	513%

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 $54.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 85610.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Fishermen's Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 85610.
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.