CMS Price Transparency Data

Blood test, clotting time (PT/INR)

Facility: Portneuf Medical Center

Billing Code: 85610 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 85610
Insurance Median: $59
Cash Discount Price: $42
vs. Medicare Baseline: 13.75x Medicare

The contracted insurance negotiated median rate for a Blood test, clotting time (PT/INR) at Portneuf Medical Center is $59. 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 $4.29, this hospital’s rate is 13.75x the Medicare baseline. Located in 777 Hospital Way, Pocatello, ID.

Cash / Self-Pay

$42

Average discount available for prompt cash payment at this facility.

Insurance Median

$59

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: $42 (979%)

Insurance Median: $59 (1375%)

Cash: $42 (979% of Medicare)

Ins. Median: $59 (1375% 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 1375% of the Medicare baseline (a markup of 1275%). 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	$14 - $59	326%
Healthscope Benefits [2290]	$14	326%
UnitedHealthcare	$14 - $63	326%
Black Lung [6055]	$29	676%
Employee Benefit Management Services [2445]	$29 - $42	676%
Healthcare Highways [2210]	$29 - $66	676%
Lucent Health [6000]	$29	676%
Moda Health [6100]	$29	676%
Oncology Patient Assistance Programs [2295]	$29	676%
Pending Ssi [1616]	$29	676%
Web Tpa [2115]	$29	676%
Pacific Source Health Plans [2850]	$40	932%
Liberty Health Share Lhs/Medcost Solutions Llc [2400]	$42	979%
Medishare Christian Care [1645]	$42	979%
Multiplan [1680]	$47 - $66	1096%
Worker'S Comp [2125]	$51 - $52	1189%
Cigna	$52	1212%
Enablecomp [1350]	$52	1212%
Transamerican Life [1990]	$52	1212%
First Health [1375]	$58	1352%
Mailhandlers [1595]	$59	1375%
Selecthealth [3740]	$59 - $63	1375%
Geha [1415]	$63	1469%
Humana	$63	1469%
Administrative Concepts [1005]	$66	1538%
Healthfirst [2395]	$66	1538%
Healthnet [1495]	$66	1538%
Hometown Health [2155]	$66	1538%
Mayo Clinic Health Solutions [2280]	$66	1538%
Meritain Health [1655]	$66	1538%
Mutual Of Omaha [1685]	$66	1538%
National Association Of Letter Carriers [1695]	$66	1538%
New Era Life Insurance Company [1705]	$66	1538%
Pan American Life Insurance Co [1770]	$66	1538%
Pba [1775]	$66	1538%
Phcs [1780]	$66	1538%
Planned Administrators Inc [2360]	$66	1538%
Trustmark [2030]	$66	1538%
Ut Id Teamsters [3760]	$66	1538%

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: 85610.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Portneuf Medical Center 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.